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Why Aren't Rx Weight-Loss Drugs More in Demand?

Expanding Market continued...

In the two clinical trials that led to Qsymia’s FDA approval, people treated with the recommended starting dose lost 6.7% more weight in a year than those given a placebo pill. People treated with the highest dose lost 8.9% more weight in a year than those on a placebo.

In the three clinical trials that led to Belviq’s FDA approval, people who took the drug for up to 1 year on average lost 3% to 3.7% more compared to placebo. Both medications are supposed to be used along with lifestyle changes, namely eating less and exercising more.

Even if doctors prescribe the pills, patients are likely to find their health insurance won’t pay for them, Smith says. “Coverage is key,” he says, noting that fewer than half of health insurance companies cover weight-loss drugs. “We have 50, 60 diseases that are caused by obesity. We’re happy to replace your knees, but we’re not addressing the root problem."

Trimming Costs

Obesity specialist Caroline Apovian, MD, a professor of medicine at the Boston University School of Medicine, says lack of insurance coverage for anti-obesity medications is the reason phentermine, a generic drug, is the most-prescribed weight-loss drug in the U.S.

Years ago, phentermine was combined with fenfluramine, in a drug known as fen-phen. The drug was widely prescribed for weight loss until the FDA banned fenfluramine in 1997 after it was linked to heart valve problems.

Phentermine was not taken off the market. It is also one of the two ingredients in Qsymia, along with topiramate, a medication also used to control seizures and prevent migraines.

While phentermine, a stimulant similar to an amphetamine, is more likely to cause insomnia, palpitations, and anxiety than Qsymia and Belviq, Apovian says, it costs only $11 a month. “That explains everything,” she says.

The companies that market Qsymia and Belviq offer 2 weeks of their drugs for free, and then $75 off the retail price for each of 12 30-day filled prescriptions. But patients still end up paying as much as $200 a month out-of-pocket, Apovian says. “Believe me, they tell me about how much it costs them.”

If people are willing to pay for Qsymia or Belviq, Apovian says, she considers their medical history, family history, and other medications they’re taking in trying to decide which drug to prescribe. “Sometimes you try one, and then you try the other,” she says.

“The drugs seem to be just as effective as in the trials,” she says of her experience with her patients. But, she adds, it’s “hard to keep people on them as long as 1 year due to price.”

Loss of Appetite, Pounds

One of Apovian’s patients, 29-year-old Versey Bell, took Qsymia for a month but had to stop because her insurance didn’t cover it, and she couldn’t afford to pay out of pocket. But several months later, Bell’s financial situation improved, and she started taking the drug again.

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