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How dangerous is it to have a new $1k/month bill you need to pay forever? So far there is no indication insurance companies are going to pay for 100 million Am

How dangerous is it to have a new $1k/month bill you need to pay forever? So far there is no indication insurance companies are going to pay for 100 million Americans going on Ozempic who aren't diabetic... Anecdotally, another danger is people confusing less eating with a healthy diet. I know someone on Ozempic...eats less but what is eaten is the same old junk...

lotsofpulp 3y ago
Given a significant percent of voters are overweight and obese, it would be very politically popular to legislate that health insurance must pay for GLP-1 antagonists.
- Atsuii 3y ago
  Wouldn't this cause insurers to have to raise their premiums for everyone substantially?
  - ouid 3y ago
    No. The additional costs to the healthcare system due to people being overweight probably exceed 12000/person/year, but if not exceed it, they certainly come close. Moreover, it's not unheard of to mandate cheaper drug prices, and now that we understand how these drugs work, there will be more of them in the pipeline.
    - nwiswell 3y ago
      > The additional costs to the healthcare system due to people being overweight probably exceed 12000/person/year This is a big claim to assert without evidence. If it was the case then insurers would already be adding the drugs to their formularies. There is undoubtedly a cost associated with obesity but you are suggesting that simply being overweight doubles the average cost of care[1], a figure that already includes overweight and obese people (which are of course a huge population in the US). A quick Google search turned up a report[2] that suggests that > This estimated public cost equates to an average marginal cost of $175 per year per adult for a one unit change in BMI for each adult in the U.S. population. So, even for the extreme case of a very obese person that has a very successful treatment and goes from 40 BMI to 25 BMI, you are only saving a hypothetical $2,625 per year (perhaps an underestimate due to inflation and the age of the paper). Therefore it would appear that unless insurers strike a deal with the drug companies (lower the price, make it up in volume), such a law would dramatically increase insurance premiums. A better compromise would be a law which requires insurance companies to offer co-insurance on these drugs up to the expected savings. [1] https://www.pgpf.org/blog/2023/01/why-are-americans-paying-more-for-healthcare#:~:text=The%20United%20States%20has%20one,only%20about%20half%20as%20much https://www.pgpf.org/blog/2023/01/why-are-americans-paying-m.... [2] https://vinecon.ucdavis.edu/wp-content/uploads/2019/04/cwe1201.pdf https://vinecon.ucdavis.edu/wp-content/uploads/2019/04/cwe12...
      - atchoo 3y ago
        You can also factor in that all those obesity related heart complications will turn into an extra decade of cancer treatments.
      - Ginden 3y ago
        > If it was the case then insurers would already be adding the drugs to their formularies. American healthcare system has perverse incentivizes. Most unhealthy groups are generally least likely to be privately insured, so insurers are incentivized to prioritize health issues affecting working-age adults, while neglecting those which will be someone's else concern in future.
  - c0m 3y ago
    Why would a $1k/month drug increase costs more compared to the status quo of expensive bariatric surgeries and complicated heart failure/joint issues/osteoarthritis/sleep apnea etc. cases that arise from obesity? Massively reducing obesity rates seems like a good thing from the POV of an insurer.
ed_elliott_asc 3y ago
Move country, it costs about a tenth of that in the UK. One month supply us about £135 which is about $170 at todays rate.
AnIdiotOnTheNet 3y ago
> Anecdotally, another danger is people confusing less eating with a healthy diet. I know someone on Ozempic...eats less but what is eaten is the same old junk... There is anecdotal evidence that eating less is, in itself, so much more healthy that it doesn't really matter what you eat. Nutrition professor Mark Haub ate nothing but "convenience store food" for 10 weeks at a caloric deficit and all of his health metrics improved while he lost 27lbs. http://www.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/index.html http://www.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/...
prepend 3y ago
> So far there is no indication insurance companies are going to pay for 100 million Americans going on Ozempic who aren't diabetic... What’s the cost/benefit of weight loss and diabetes control vs $12k/year? I would expect people with high obesity are very expensive to insure and insurance can’t drop people any more. It may be cheaper to pay for ozempic (especially at whatever negotiated rate insurance pays) than to pay for the alternative negative health outcomes. That and ozempic goes generic in 2031 and mounjaro in 2027 so soon this won’t be a question of $1000/month but maybe $1000/year at which point insurers will probably force customers to take it or pay higher rates.
- smileysteve 3y ago
  Most of the data is showing that Ozempic is not required long term though so a single year might be all that's required; and for the morbidly obese; $12k is going to be less than the typical admission to a hospital (for injury, illness, heart disease, diabetes related incident.)

lotsofpulp 3y ago

Given a significant percent of voters are overweight and obese, it would be very politically popular to legislate that health insurance must pay for GLP-1 antagonists.

Atsuii 3y ago
Wouldn't this cause insurers to have to raise their premiums for everyone substantially?
- ouid 3y ago
  No. The additional costs to the healthcare system due to people being overweight probably exceed 12000/person/year, but if not exceed it, they certainly come close. Moreover, it's not unheard of to mandate cheaper drug prices, and now that we understand how these drugs work, there will be more of them in the pipeline.
  - nwiswell 3y ago
    > The additional costs to the healthcare system due to people being overweight probably exceed 12000/person/year This is a big claim to assert without evidence. If it was the case then insurers would already be adding the drugs to their formularies. There is undoubtedly a cost associated with obesity but you are suggesting that simply being overweight doubles the average cost of care[1], a figure that already includes overweight and obese people (which are of course a huge population in the US). A quick Google search turned up a report[2] that suggests that > This estimated public cost equates to an average marginal cost of $175 per year per adult for a one unit change in BMI for each adult in the U.S. population. So, even for the extreme case of a very obese person that has a very successful treatment and goes from 40 BMI to 25 BMI, you are only saving a hypothetical $2,625 per year (perhaps an underestimate due to inflation and the age of the paper). Therefore it would appear that unless insurers strike a deal with the drug companies (lower the price, make it up in volume), such a law would dramatically increase insurance premiums. A better compromise would be a law which requires insurance companies to offer co-insurance on these drugs up to the expected savings. [1] https://www.pgpf.org/blog/2023/01/why-are-americans-paying-more-for-healthcare#:~:text=The%20United%20States%20has%20one,only%20about%20half%20as%20much https://www.pgpf.org/blog/2023/01/why-are-americans-paying-m.... [2] https://vinecon.ucdavis.edu/wp-content/uploads/2019/04/cwe1201.pdf https://vinecon.ucdavis.edu/wp-content/uploads/2019/04/cwe12...
    - atchoo 3y ago
      You can also factor in that all those obesity related heart complications will turn into an extra decade of cancer treatments.
    - Ginden 3y ago
      > If it was the case then insurers would already be adding the drugs to their formularies. American healthcare system has perverse incentivizes. Most unhealthy groups are generally least likely to be privately insured, so insurers are incentivized to prioritize health issues affecting working-age adults, while neglecting those which will be someone's else concern in future.
- c0m 3y ago
  Why would a $1k/month drug increase costs more compared to the status quo of expensive bariatric surgeries and complicated heart failure/joint issues/osteoarthritis/sleep apnea etc. cases that arise from obesity? Massively reducing obesity rates seems like a good thing from the POV of an insurer.

ed_elliott_asc 3y ago

Move country, it costs about a tenth of that in the UK. One month supply us about £135 which is about $170 at todays rate.

AnIdiotOnTheNet 3y ago

> Anecdotally, another danger is people confusing less eating with a healthy diet. I know someone on Ozempic...eats less but what is eaten is the same old junk... There is anecdotal evidence that eating less is, in itself, so much more healthy that it doesn't really matter what you eat. Nutrition professor Mark Haub ate nothing but "convenience store food" for 10 weeks at a caloric deficit and all of his health metrics improved while he lost 27lbs. http://www.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/index.html http://www.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/...

prepend 3y ago

> So far there is no indication insurance companies are going to pay for 100 million Americans going on Ozempic who aren't diabetic... What’s the cost/benefit of weight loss and diabetes control vs $12k/year? I would expect people with high obesity are very expensive to insure and insurance can’t drop people any more. It may be cheaper to pay for ozempic (especially at whatever negotiated rate insurance pays) than to pay for the alternative negative health outcomes. That and ozempic goes generic in 2031 and mounjaro in 2027 so soon this won’t be a question of $1000/month but maybe $1000/year at which point insurers will probably force customers to take it or pay higher rates.

smileysteve 3y ago
Most of the data is showing that Ozempic is not required long term though so a single year might be all that's required; and for the morbidly obese; $12k is going to be less than the typical admission to a hospital (for injury, illness, heart disease, diabetes related incident.)