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It’s very expensive at $10k/year/patient, but I wonder if the long term costs are still cheaper than treating heart attack or stroke. Obesity greatly increases the risk of cardiovascular events so I think this may end up saving Medicare money by shifting to pharmaceuticals from emergency care.

Of course, would be nice if they would negotiate a lower price as it’s really expensive.

But Medicare covers other chronic preventative meds, PReP coming to mind and that’s like $10k/year. But still way cheaper than HIV treatment that it prevents.

It’s around £250 a month in the UK privately, when it falls under the NHS fully it will likely be even cheaper.

There is absolutely no reason for it to cost $10K per year in the US.

I’m more worried about the long term effects of it, we had plenty of “miracle drugs” in the past that resulted in significant damage long term to either those who took them or to their children.

The cost of 10k per year is very likely to drop over time, especially if there's a huge roll out for millions of people. I think statistics calculations will show a net positive effect in terms of long term health care savings, unless Wegovy has serious side-effects that counter the benefits.
Depends on what the long term side effects are.

Fen-phen reduced obesity for some, but the heart damage it caused made it more expensive than no intervention. [1]

[1] https://en.m.wikipedia.org/wiki/Fenfluramine/phentermine

Blue cross has $450 / mo negotiated rate. Medicare can do better than that and government has started doing negotiations for drugs.
It's 88 EUR/month in my EU-Baltics country. I'd say it can be made much cheaper here and therefore in the US as well.
For comparison, (as far as I know) the drug with the most revenue per year is Humira which costs roughly the same per year and has several million customers globally.
There are several anti-obesity drugs in the pipeline that work through similar mechanisms that should be entering the market which should lower the price through competition.

Heart disease, diabetes, and fatty liver disease are some of the most common killers and the reduction in excess body fat will causally and significantly lower the risks for all of them.

I’m all for it. Initial results seem very promising, especially for those struggling to get to their target weights. I was initially skeptical of it especially given the massive marketing push for off label usage (reminded me of fentanyl/oxy or certain amphetamines for weight loss).

Personally, just adjusting lifestyle (reducing intake of sugary and artificially sweetened foods; exercise; and intermittent fasting) over a sustained period of time (3-4 months) helped me drop 40 lbs. OTC supplements like vitamin d, and omega fish oil added to regimen (as recommended by doctor).

It's very effective for sure. But I also think it's ripe for abuse. I've seen healthy people on it to lose only 10 lb instead of making slight changes. I don't think we know enough about its long term effects and how damaging it can be to be on severe calorie restriction for some periods of time. It's like an induced eating disorder in a way and I wonder about the psychological changes that accompany it.
We should stop thinking of this complex in terms of "abuse" and "slight changes". We suck to varying degrees and obesity is obviously a societal issue. We need help.

We should keep looking for better options, we can and should always keep an eye on potential consequences down the line — and we can always elongate that line — but the very real, proven consequences of being overweight/having high blood pressure can be calculated like those that are attached to burning coal and they are worth tackling without prejudice, within the guidelines of what good science deems safe.

Anything we can do to help with cardiovascular issues needs to be explored. Doing otherwise would simply be immoral and irresponsible. We have tried eating salads and going for quick walks. It's always great when that's enough to change one person for the better. When it's not, we should help with empathy. Currently, there simply is no clearer, quicker path to doing more than these drugs, on a societal level.

I lost 40 pounds the classic way. Just better diet, eating less.

And like the majority of people who lost weight, I gained it back.

Why? I don’t know. My body just wants to eat more. I have to be constantly vigilant or else I’ll fall into my old habits of what my body demands that I eat. I’ll eat dinner and then still be hungry.

I think you’re getting this backwards. I already have an eating disorder.

How is that abuse?

Obviously meds don’t work for everyone, but the aim is to have population level effects.

Note that seniors are actually some of the biggest cohorts using the new GLP1 Receptor Agonists:

https://glp1.guide/content/senior-citizens-and-glp1-receptor...

Also as some other people have noted, those costs seem high now, but they're certain to go down over time (due to competition and other companies entering the market along with other countries), and almost certainly worth the cost -- type 2 diabetes can be very expensive, along with all the other effects from complications of obesity.

For example, Wegovy has actually been FDA approved for reducing heart disease risk:

https://glp1.guide/content/news-fda-approves-wegovy-for-redu...

I've heard from random podcasts (do your own research) you need to make sure you exercise, and perhaps eat high protein, while on drugs like this, otherwise you lose a ton of muscle mass. Could be deadly for seniors, where falls are a leading cause of death.

See https://www.ncoa.org/article/get-the-facts-on-falls-preventi....

This is not to say the drug is bad, simply to encourage education so we dont trade one problem for another.

> I've heard from random podcasts (do your own research) you need to make sure you exercise, and perhaps eat high protein, while on drugs like this, otherwise you lose a ton of muscle mass. Could be deadly for seniors, where falls are a leading cause of death.

This isn't true in the sense that it's because of GLP1 RAs in particular -- it's just that GLP1 RAs are effective at rapid weight loss, and that's what happens when you undergo rapid weight loss REGARDLESS of method.

It's a trade-off -- do you want to manage muscle loss and bone density issues (with an easily modifiable dosage/etc) or manage type 2 diabetes or heart disease for the same patient?

Why is it we can spend 10k/year on our car, but not 10k/year on ourself. We have to ask our government/insurance to pay. Makes no sense.
Who spends 10k/year on a car, that seems incredibly high. Also I'd say most people spend more than 10k/year indirectly on upgrading their health, but I'd count things like "not eating cheap food all the time" as one of those, or for example, moving to a places in less crime-ridden areas. And people rationally will spend money like that before they try experimental drugs.

Also - you can't really go buy this OTC anyway so it's not really a substitutable good.

A bit aside, I am bullish on these compounds. Tirzepatide is a discovery on the same order of magnitude as any - even potentially bigger than all the recent ML stuff. It's not even close to it's full potential. The data shows it's the only thing we have that really squashes diabetes and obesity with minimal side effects, but also has big positive effects on addiction, heart, bones, liver, brain, and immune system.

The addiction effects alone could change the world tremendously for the better if it's made easier to get and easier to ingest. I gave one of my Mounjaro shots I wasn't going to use to someone who had been trying to quit cigarettes for a decade and they were basically in tears a few days later telling me they went two full days without smoking, the first time they'd ever even gone a few hours since they were young.

You clearly don't know a lot of people who aren't wealthy. The majority of people I know couldn't spend 10k on anything except absolute necessities, let alone a car. Of those who do have vehicles, none of them spend $10k/year and if they did it would damn near break them.

Seriously, I don't mean to be rude, but god damn this is out of touch for people who are struggling.

You're in a bubble man. Not everyone is paying $800 a month for a car. Millions of people buy a cheap crappy car outright, and drive it for years.
This is just whataboutism, and is bullshit
It's about £2,500 ($3,100) per year in the UK if you just buy it online, not subsidised. I don't know how the US massive price hike is justified when the whole western world is buying it from the same supplier (Novo Nordisk in Denmark).
The US market is paying for the R&D while the rest of the world is getting it below cost.
I bet this will end up saving the government a lot more than it costs. On the other hand, the side effects and long term effects of these new drugs are not well known. I wouldn’t be surprised if some of the common GI side effects become something more serious.
Without discounting the cases that are genetic or as a result of some other illness, for whom such a pill is a godsend, most obesity is due to lifestyle and especially all the processed foods (not to mention soda!) that Americans eat and drink.

I'd rather my taxes go to preventing obesity in the first place then paying for a pill that helps relieve its symptoms (but does not fix the underlying cause), is expensive, and has side effects. Make it harder to life an unhealthy lifestyle, just as we've made it a lot harder to smoke over the past 40 years. Start by taxing sodas and processed foods for one and use the money to subsidize healthier foods and prevention of "food deserts" in lower income areas (given that obesity is highly correlated with low income which is highly correlated with unhealthy diet -- it's hard to stay healthy when all you have nearby are corner stores stuffed with Frito Lay and Coke.

To me it's another example of how we really have our priorities backwards.

> Make it harder to life an unhealthy lifestyle

Well, and that's exactly what these drugs do: they either make you uninterested in processed foods or make you ill if you consume them. Considering how many people's dietary habits are formed in childhood, and considering how many people learn dietary habits from their parents, I could see GLP-1 agonists having a generational effect where the children of people who take them never get hooked on bad food to begin with.

Although for what it's worth, you're absolutely right about food deserts and income, I sadly just don't see those things getting tackled head-on unless political winds in the US shift dramatically. On the other hand, making junk food less profitable to its creators might actually force some change, as backwards as that is.

It’s not that there are no other interventions for obesity, it’s just that this is the cheapest and most effective.

If taxing sodas had the effect of reducing body weight by 1/3, then I’d be all for it.

But behavioral interventions are really hard to stick. The reason ozempic is taking off is that it works given the systemic issues we have.

It’s the equivalent of saying people shouldn’t take anti-depressant meds because we can just change systemic factors they cause depression.

We can do both, but it’s not like we’d discourage food deserts instead of ozempic. We need to do both. And cynically, I think ozempic will work to reduce obesity.

Realistically, none of those things have happened in a way that puts a dent in ever climbing obesity rates. I think it’s time we celebrate the pharmaceuticals and pay up. This is one of those times where technology might solve a social problem.
> To me it's another example of how we really have our priorities backwards.

Not if your priority is to maximize shareholder value

Identify a cheaper way of getting people to change lifestyle that is actually possible to get agreement on and that actually works, and you'd be showered with money.

Trying to get support for changes to what food is available etc. may well be better in the long term, but in the short term you're doing the equivalent of asking a bunch of addicts (me included) to voluntarily vote to banish our dealers.

Many of us will, but the measures will remain weak enough that we'll still find ways of satisfying the addictions anyway.

A friend of mine is earning millions of dollars / month connecting people to this drug. The trick is working out the insurance company rules. With Medicare they're going to be rich as fuck. Just a giant pump of taxpayer dollars into this. It's going to be fantastic.
How does this work?
Instead of spending money on Wegovy, spend the money on Novo Nordisk stock.
Say what you want but pharmaceuticals are perhaps the only hope America has against the obesity epidemic.
Or better regulation.

Treating refined sugar as the addictive substance it is, and keeping those products in a separate part of the store rather than at the checkout line. Removing subsidies for unhealthy ingredients, subsidising healthier ones. More education in schools. Better funding and requiring school districts to meet certain quality standards for the food they provide to children. Ensuring all children have the right to a healthy meal. Where previous initiatives have fallen short, critically evaluate why and make them better. Thinking about social psychological factors for our collective mental health and thinking about how this influences our dietary and exercise choices.

There are lots of actions that could be taken that are not just pharmaceutical.

Sugars make people happy, fat and happy people don't revolt
Or GLP-1 pathway targeted gene therapy.
That's certainly a take, but without reasoning or evidence, this isn't a very interesting comment.
There goes my chances of getting any for my diabetes this decade :(
Where in the world is this even available?

Not to be had at any price in Australia.

The manufacturer is buying every plant they can get their hands on. With this amount of money at stake, they'll manage it pretty quick.
this should not be on Hacker News
Maybe insurance should cover if an obese person is already walking 10000 steps per day for a year and not able to lose weight.
Why ? Leaving aside the obvious issue of humanity and basic decency, You are paying for the insurance no matter what anyway due to all the related illnesses [1] from obesity

Should now insurance not cover heart attacks or diabetes or other illnesses strongly correlated with weight for obese people ?

Where does that stop ? When is it not fault ? Should insurance not cover if you injured in sports(been careful) Or work place injuries (choosen a different job ) ?

[1] this is the same dumb deserving argument for uninsured, they are still getting treated in ER usually repeatedly when it would be cheaper to cover them

That’s a solid 12k+/year for eligible patient. Have no issue so long as it’s capped to an order of months to avoid it being a forever med. otherwise we’ll see all our insurance premiums and Medicare taxes rise dramatically.
Now, do the math on leaving obesity unchecked. Hip replacements, heart attacks, diabetes…

Medicare should easily be able to negotiate some volume pricing, now that they’re legally permitted to finally.