Price of anti-obesity medications limits access for those most in need

Recent results from clinical trials and studies assessing anti-obesity medications, in addition regulatory approvals, has resulted in increased patients interest demand. Whilst there is little doubt that the results are encouraging and certainly warrant further investigation, indeed this latest generation of for anti-obesity medications may have a significant role ion pre- and post-bariatric surgery patients. However, access to these medications has proven to be problematic, most notably due to the costs involved. Study by led by researches from Royal Free Hospital NHS Trust, London, UK, “Estimated minimum prices and lowest available national prices for antiobesity medications: Improving affordability and access to treatment”, published in the journal Obesity, has concluded that certain weight loss treatments can be manufactured and sold profitably at low costs, but prices currently range widely between countries, limiting access for those in need.

For the study, the authors reviewed current treatment costs and calculated potential estimated minimum prices (EMPs). The authors searched national drug price databases across various countries for orlistat, naltrexone-bupropion, topiramate-phentermine, liraglutide, semaglutide and tirzepatide. EMPs for anti-obesity medications were calculated using established methodology, using active pharmaceutical ingredients (API) from the Panjiva database. EMPs were calculated per 30-day course and include costs of active pharmaceutical ingredients, excipients, formulation, taxation and 10% profit margin.

Due to the differing doses, the researchers based their calculations on the following:

• Orlistat EMP was calculated for 120 mg three times per day

• Topiramate/phentermine EMP was calculated for 92 mg/15 mg once per day (OD)

• EMP for naltrexone/bupropion was calculated for 8 mg/90 mg four times per day

• EMP for semaglutide was calculated for 14 mg OD (PO) and for 2.4 mg (S/C) once per week (rounded to 10.25 mg per 30 days); and

• Liraglutide EMP was calculated for 3 mg OD (S/C). Prices were also searched for tizepatide (S/C) at a single 15 mg dose per week.

Outcomes

Overall, they noted that prices were found to range significantly between countries (Figure 1). More specifically they noted:

• Phentermine/topiramate (oral) is not licensed for use for weight loss in several countries because of safety concerns, and, of the 16 countries searched, price data were available only in the US, where it ranged from $120 to $199 per course, in comparison with the EMP of the combination tablets ($5). When they also searched for individual national prices of topiramate and phentermine separately and combined the available data together (from the US, South Africa, and Kenya), the EMPs for each drug individually were $0.86 for topiramate and $0.53 for phentermine (total of $1.39 per course) based on API export data.

• The price for Naltrexone/bupropion (oral) combination tablets, ranged from $326 in the US to $56 in South Africa, compared with an EMP of $55 per 30-day course.

• Semaglutide (oral) ranged from $578 (US) to $65 (India) per 30-day treatment course.

• Liraglutide costs $1418 in the US and $252 in Norway, whereas the EMP per 30-day course was $50.

• Semaglutide (injection) was calculated to be about $40 per 30-day course. National price data available for subcutaneous semaglutide were all higher than the researchers’ EMP, ranging from $804 (US) to $95 (Turkey) per 30-day course.

• There was insufficient data for Tirzepatide (injection) to calculate an EMP, and national price data were available only in the US, where tirzepatide was recently licensed for use in T2DM by the FDA and prices per 30-day course ranged from $715.56 to $1100.70.

Figure 1: Estimated minimum prices and lowest available national prices for antiobesity medications: Improving affordability and access to treatment - (A) Course prices for orlistat (PO). (B) Course prices for phentermine/topiramate (PO). Few prices were available for combination tablets so * (including EMP1) marks prices calculated by adding together price data for courses of individual tablets of topiramate and phentermine. Prices without * (including EMP2) are for combination tablets. (C) Course prices for naltrexone/bupropion (PO). (D) Course prices for semaglutide (PO). (E) Course prices for liraglutide (S/C). (F) Course prices for semaglutide (S/C). (G) Course prices for tirzepatide (S/C). EMP, estimated minimum price; PHARM, US Drug Online Pharmaceutical Drug Price Database; PO, orally; QDS, four times per day; S/C, subcutaneous; TDS, three times per day; VETS, US Department of Veterans Affairs Medical Insurance Drug Price Database

“We show that many of these drugs could be sold profitably at even lower EMPs, all of which include a 27% tax and 10% profit margin” the researchers concluded “…This research shows that many effective anti-obesity medications can be manufactured and sold at prices that include a 10% profit margin for almost 20-fold less than they are currently available for in a wide range of countries,”. “Health care systems should prioritise lowering prices and improving access to effective anti-obesity medications to help fight the growing obesity pandemic.”

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