2/29/2024 –
With ever-rising global adiposity, glucagon-like peptide 1 (GLP-1) agonists are shifting the treatment landscape. In trials, GLP-1 agonists produce placebo-adjusted weight loss of 12% to 18%—exceeding any prior pharmacologic therapy and generating enormous attention and utilization. From 2021-2023, the stock price of 2 manufacturers, Novo Nordisk and Eli Lilly, more than tripled, with a combined valuation now greater than $1 trillion.
Yet clinical and public confusion exists around real-world costs, tolerability, and access. One-half of US adults are interested in taking a prescription weight-loss drug,1 and 93 million meet GLP-1 weight-loss eligibility criteria.2 US list prices are $12 000 to $16 000 per year; even with maximum negotiated discounts, costs will likely exceed $6500 per year. If all eligible US adults received GLP-1 agonists at discounts, the annual cost would be $600 billion—equal to all other US prescription drug spending combined. There are hopes that competition will lower prices, but each GLP-1 agent is protected by approximately 20 patents, many to 2040 or beyond.3 Even if current prices decrease, experience with other major drug classes suggests that newer agents in this class will be introduced, with incremental benefits but continuing high prices and aggressive marketing, making it unlikely that total costs will meaningfully decrease soon.
