April obesity prescriber survey: Treatment time rises | Insights | Bloomberg Professional Services

This analysis is by Bloomberg Intelligence Senior Industry Analysts Michael Shah and John Murphy. It appeared first on the Bloomberg Terminal.

Rising treatment duration for obesity drugs may offer 5%-plus upside to our $80 billion sales view for 2030, based on April’s BI survey, yet physicians still face hurdles getting patients onto Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound. That’s despite improving supply and coverage and a willingness by some patients to pay out of pocket.

Insurance, supply still obstacles to uptake

Of 100 prescribers surveyed, 85 said up to 50% of patients were paying out of pocket, with 36 respondents falling into the 10%-or-less bracket, similar to the August and March 2023 results. As before, almost all reported hurdles getting patients on therapy. Most were cost- and insurance related and include prior authorizations, step-edits and reimbursement difficulties for patients without co-morbidities. That’s despite 50 million people being covered for Novo Nordisk’s Wegovy in the US.

Supply remains an issue, given the gradual ramp-up in manufacturing capacity against unprecedented demand for Wegovy and Eli Lilly’s Zepbound. A quarter of respondents saw patient unwillingness or adherence as barriers, highlighting the need for orals and new mechanisms, which could potentially offer improved tolerability.

Patients show willingness to pay if rejected by insurers

On average, about half of obesity patients treated by our surveyed physicians aren’t covered or are rejected by insurance for GLP-1 treatment. Of those, more than a quarter then go and pay out of pocket. Further competition and oral GLP-1 therapies coming to market over the medium-to-long term will likely see treatment costs decline. This, together with further data around co-morbidities, may help fuel insurer coverage as well as boost appetite among those not covered to pay out of pocket. That all points to significant volume increases in an elastic market that’s currently underpenetrated.

The net cost of high efficacy GLP-1 treatments Wegovy and Zepbound ranges between $500-$700 per month, based on our calculations, which assumes rebates of 55%-60%.

Insurance Coverage and Out-of-Pocket Payment

GLP-1 use lifts with Zepbound poised to overtake Wegovy

On average, 40% of obesity patients treated by BI surveyed physicians are prescribed Wegovy vs. 26% for Zepbound, which was indicated for the disease in 4Q. Zepbound use could rise to 36% in 18 months time, with Wegovy slipping to 34%, respondents suggest, while switches seem unlikely. Several doctors cite Zepbound’s superior efficacy, while others point to familiarity and success with Wegovy and highlighted its cardiovascular risk benefit that’s now on-label and could fuel coverage. Views on insurance and supply for each drug were mixed, and are factors that could ultimately dictate prescribing decisions.

Prescriber expectations for Wegovy and Zepbound have risen modestly since our August survey, while those for oral semaglutide have fallen, possibly due to an extended approval timeline and improving injectible supply.

Anticipated GLP-1 Utilization Over Next 18 Months

Treatment duration may continue to lengthen

Our physician survey suggests patients stay on Wegovy for an average of 39 weeks vs. 40 weeks for Zepbound, which was only formally launched for obesity in 4Q, so experience is likely partly based on clinical trials and off-label use. That compares with 35-36 weeks in the August survey, when several respondents also envisaged chronic use, a view supported by Novo and Lilly’s respective studies. A longer treatment duration alone implies 5% upside to our 2030 obesity market sales view of $80 billion.

Limiting factors include cost, supply and insurance, though these are likely to improve. Tolerability issues, which usually occur during the titration phase, may weigh on treatment duration. Wegovy may have benefited from Novo’s management of lower doses to safeguard continuity of care, supply of which resumed in January.

Average Treatment Duration (Weeks)

Repeat-responder sub-analysis mirrors overall findings

Of the 100 participants surveyed in April, 58 were repeat respondents from our August survey. Analysis of this subset shows consistent trends to the overall results, especially with regard to prescriber hurdles. Subgroup data show a slightly higher increase in the proportion of patients paying out of pocket vs. the full dataset, which may simply reflect more patients seeking treatment. Similar increases in treatment duration for Wegovy and Zepbound were observed between the analyses, with utilization trends also on par, both in terms of current and anticipated usage.

While prescriber splits by medical specialty appear broadly alike, a slightly higher percentage in the subgroup had experience with Zepbound compared with the overall survey pool. Highlighted differences are marginal and don’t affect our conclusions.

Key takeaways from repeat responder sub-analyses:

• On average, 31% of patients were paying out of pocket in April 2024 vs. 28% in August 2023
• About 95% of prescribers said they face obesity treatment hurdles vs. 100% in August
• Sub-analysis suggests the proportion of Wegovy use may drop over next 18 months, like in the full dataset
• April subgroup data show Wegovy and Zepbound stay-times of 42 and 41 weeks respectively, vs. 38 and 36 weeks in August

Bloomberg Intelligence obesity prescriber survey methodology

Bloomberg Intelligence surveyed 100 US-based prescribers, all of whom closely follow developments in obesity and have experience prescribing semaglutide (Wegovy, Ozempic) and/or tirzepatide (Zepbound, Mounjaro). Seventeen were primary-care physicians, with the remainder specialized in gastroenterology (22), endocrinology (26), cardiology (28) or bariatrics (7). Fifty-eight also participated in the second iteration of the survey, carried out in August 2023. We aim to revisit this survey on a periodic basis.

Prescribers Split by Specialty