In Episode 49 of the Pound of Cure Weight Loss Podcast, Dr. Weiner and Zoe examine the steep costs of obesity medications like Wegovy, the influence of pharmacy benefit managers (PBMs), and the role of big pharmaceutical companies in shaping healthcare. Highlighting recent Senate hearings led by Bernie Sanders with Novo Nordisk’s CEO Lars Fruergaard Jørgensen, this episode sheds light on how the current system prioritizes profit, often at the expense of patients’ access to care.

Wegovy Cost: Breaking Down High Prices in the U.S.

Wegovy, a GLP-1 medication, costs around $1,349 per month in the U.S., while in other countries like the U.K., prices are as low as $92. Dr. Weiner explains that this discrepancy illustrates a broken healthcare model, where the U.S. market fuels corporate profit but leaves millions unable to afford essential treatments. With 72% of Novo Nordisk’s revenue coming from U.S. sales, the company’s pricing strategy relies on American consumers, who are left paying significantly more for the same medications.

Big Pharma’s Influence on Policy and Profits

This episode delves into Big Pharma’s control over drug pricing, particularly the stark contrast between their research and development costs and their profits. For example, while Novo Nordisk spent $21 billion on R&D, they spent twice as much—$44 billion—on stock buybacks and dividends. Dr. Weiner highlights how political influence plays a crucial role, with both major parties receiving substantial donations from pharmaceutical companies, leading to stalled efforts in drug price regulation and patient access.

Pharmacy Benefit Managers (PBMs): Hidden Gatekeepers Driving Up Costs

PBMs, the intermediaries between insurers and pharmacies, are supposed to negotiate better prices, but Dr. Weiner and Zoe point out that they often drive costs higher through hidden fees. In many cases, PBMs have financial incentives to push higher-priced drugs, creating a “pay-to-play” system that limits patient access. For example, PBMs profit by taking a percentage of negotiated drug price savings, meaning higher drug list prices generate greater profits for them. Dr. Weiner underscores how PBMs complicate and inflate pricing, making it even harder for patients to get GLP-1 medications through insurance.

Do We Need Health Insurance Companies and PBMs?

Dr. Weiner questions the necessity of insurance companies and PBMs in the healthcare system, arguing that they don’t provide direct patient care yet extract billions from the system. He suggests that healthcare can function without these financial middlemen, allowing for a more transparent, patient-centered system where costs are lower and patients have better access to needed treatments.

The Morality of Obesity Treatment Costs

The episode closes with Dr. Weiner and Zoe discussing the stigma surrounding obesity and the moral implications of restricting access to life-changing medications like Wegovy. They emphasize that obesity is a complex, chronic disease requiring comprehensive treatment, not simply a “lifestyle” issue. Dr. Weiner advocates for recognizing obesity treatment as essential, which could lead to a shift in how these medications are accessed and covered.

Final Takeaways

While the healthcare landscape remains challenging, Dr. Weiner believes patient advocacy, legislative changes, and innovation can improve access to these life-saving treatments. This episode offers insights into navigating the current system while emphasizing the need for systemic change to prioritize patient health over profits.