The Obesity Treatment Landscape: Takeaways from the 2nd Annual BMO Obesity Summit

The medical community now firmly recognizes obesity as a complex, biologically driven disease – one that requires pharmacological intervention, not just lifestyle changes. But despite the groundbreaking treatments currently on the market, gaps in patient access, drug shortages and payer resistance are among some of the issues that continue to challenge widespread adoption. 

The race to reshape obesity therapeutics is accelerating, with oral treatments emerging as a potential game-changer in expanding access. But as key stakeholders gathered at our 2nd Annual BMO Obesity Summit in New York City, one thing was clear: scientific advancements alone won’t solve the access problem. 

The Summit explored what’s next for obesity treatment and drug developments with representatives from Eli Lilly, Novo Nordisk, Amgen, Structure Therapeutics, Corbus Pharmaceuticals, Altimmune, Superluminal Medicines, Scholar Rock and Ro. Industry leading experts from FlyteHealth, Reid Strategic and ProCare RX, sharing insights on patient care, access and delivery.  

Here are my biggest takeaways from the event.  

Even as the number of physicians certified by the American Board of Obesity Medicine has grown sharply – from just 2,000 in 2022 to 10,000 currently – there are still not enough trained clinicians to accommodate the demand. For those patients able to secure a knowledgeable physician to oversee their obesity care, many struggle with obtaining coverage for the cost of therapeutics.  

The challenges around access go beyond the lack of clinicians or infrastructure, however. Issues of weight bias, for example, continue to impact patients looking for care, and care mismanagement persists, with some studies indicating that up to 50% of patients stop taking their therapeutics after just one year. To learn more about approaches to patient care, listen to our podcast ​​Obesity 102 with Katherine Saunders, M.D., Obesity Physician and Co-Founder FlyteHealth.

All eyes are on Eli Lilly’s orforglipron, the first GLP-1 agonist that’s administered in oral pill form and currently in phase three of clinical trials. Although it’s similar to an injectable like Ozempic or Wegovy, the difference is in its molecular structure. Orforglipron is made of small molecules instead of being peptide-based, like Ozempic, which could make it easier and less expensive to manufacture. 

Not only does this new form of therapeutic offer a viable alternative for the approximately 20% of patients who won’t use an injectable, its efficacy closely resembles that of Ozempic and other injectable GLP-1 agonists. This could make it a game-changer for obesity treatment. That said, it’s important to note that each new development in therapeutics represents an additional tool for patients to access, and health care providers must ensure the right treatment is paired with the right patient. 

New players like Ro, as well as pharmacy benefit managers (PBMs) and self-insured employers, are working to expand access to GLP-1 treatments by streamlining approvals, increasing transparency and exploring alternative payment models. Ro helps patients by providing upfront cost estimates of insurance coverage, managing prior authorizations and more. ​​During one of our panels, the company’s CEO, Z​ach​​ ​Reitano, said he sees this as an opportunity to reduce the friction in traditional pathways to treatment, by incorporating direct-to-consumer shipping and virtual appointments. 

Despite these innovations, cost remains the major challenge. While GLP-1s have clearly demonstrated long-term health benefits, the short-term financial strain on insurers and employers has made it difficult to cover these treatments as extensively as patients need. Some PBMs are tightening prior authorization requirements, while others are testing alternative reimbursement models that link coverage to long-term health outcomes. Employers face a difficult decision: cover these costly therapeutics now or risk higher expenses in the years to come as employees require a host of other medications due to comorbidities.  

For more on recognizing obesity is not a singular disease and navigating payor economics, listen to ​panel podcast on Care and Delivery with FlyteHealth.  

As expected, manufacturing enough obesity therapeutics to meet the skyrocketing demand is an ongoing challenge across the board. Although companies are making investments to increase manufacturing capacity, there continues to be an impact on short-term earnings. Despite these headwinds, stakeholders were reassured that supply limitations are becoming less of a problem all the time.  

Although there is plenty of excitement surrounding the development of oral obesity treatments like orforglipron, stakeholders have mixed opinions about whether they are the answer to patient access problems. Some believe oral therapeutics offer a long-term solution for maintenance, after initial treatment with injectables, but others want to see improved efficacy – similar to tirzepatide, a newer injectable GLP-1 that has shown even more efficacy, perhaps – before they move away from injectables on a larger scale. 

The landscape of obesity therapeutics is evolving in exciting ways, but scientific breakthroughs are just the beginning. Collaboration between all stakeholders, from health care providers to pharmaceutical companies to insurers, is the key to ensuring every patient can access and benefit from the right treatment.