Senator Bernie Sanders is getting a piece of the attention being paid to weight loss drugs. Unsurprisingly, these medicines have gotten a lot of notice; losing weight and keeping it off is very hard. These medicines help people with obesity meet their weight loss and health goals. While the Senator may see personal attention from inserting himself into this, with investigations, appeals to other countries to intervene, and ineffective plans for importation, he’s wasting time. People in the U.S. who need help losing weight could benefit from his influence. The Senator should use his position as chair of the powerful Health, Education, Labor, and Pensions (HELP) committee to pass laws that would give people affordable access to weight loss medicines in the American health system.
Senator Sanders is claiming, without any basis in fact, that the weight loss drugs will bankrupt the U.S. healthcare system. This is the same false alarm he pulled for drugs for Hepatitis C and Alzheimer’s disease. In fact, several reports have demonstrated the opposite for weight loss. The government is likely spending more on healthcare by not treating obesity. Well constructed analysis showed that treating obesity is far less expensive than the Senator claims would cost far less than treating the many conditions related to obesity, such as cardiovascular disease. This fear-mongering about imminent financial ruin distracts from the real issue that makes these medicines unaffordable: the lack of insurance coverage.
In stark contrast to Medicare Part D, insurance plans offered to federal employees are required to cover weight loss treatments, including drugs. How unfair that Senator Sanders won’t put his energy behind creating this same access for seniors and disabled people in the U.S., but rather appears to prefer to put his energy into grandstanding.
When the drug benefit for seniors and disabled people in the U.S (Medicare Part D) was enacted, safe and effective weight loss medicines had not been developed. So, drugs for weight loss were excluded. Now, that has changed but the ban on coverage remains, despite bipartisan support for its removal. Senator Sanders could take his leadership on the powerful HELP committee to do something meaningful, work with his colleagues in Congress to remove the exclusion. Insurance plans could demand discounts on these drugs if that coverage block were removed. He would give the Medicare plans the muscle to bring the price down by 50 to 70 percent.
In competitive therapeutic classes like weight loss, insurance companies ask drug companies to give discounts for a preferred position on the formulary. That means the person taking the medicine gets a lower price than they would have if they had paid cash, and the insurance company pays less for the drug. This competitive market dynamic has kept the net price of medicines low, growing at well under 5% for the last several years and less than consumer inflation. Senator Sanders could also put his committee leadership behind pharmacy benefit manager (PBM) reform requiring these discounts to be passed to people, and limiting practices that drive community pharmacies out of business.
In another futile effort, Senator Sanders implored the people of Denmark to bring down Novo Nordisk drugs’ prices. But in a country with a centrally administered socialized medicine system, it isn’t people who choose what drugs are available. The government decides. They choose what drugs to cover and set a take-it-or-leave-it price. If the drug company takes it, they make the drug available to people in the system; if not, they don’t.
Sidestepping normal market competition for a dictated price comes with a cost; fewer medicines are available. For example, in Denmark's public insurance system, people can get unrestricted access to only 40% of all the medicines approved as safe and effective in the European Union. The excluded medicines are also for life-threatening diseases, including cancer, where 40% of approved medicines are available to people in Denmark without restrictions.
By contrast, in Medicare Part D, nearly 100% of FDA-approved medicines are available. Different Part D health insurers may cover different drugs, and people, not the government, get to choose a plan that covers their medicines. While not perfect, far more people can access the medicines they need compared to a system where the government has a heavy hand in pricing.
Senator Sanders also tried and failed many times to get drugs imported from Canada. This is a terrible idea for many reasons, including Canadians don’t have enough to fulfill the U.S. drug supply. He admires single-payer medicine, but that system is not what has successfully driven down medicine costs in Medicare. Most people in the U.S. still want insurance delivered through the private market. Members of Congress are placed in their positions of power to create and amend laws in the best interests of the people they serve.
Senator Sanders should focus on the job he has been elected to do and create a consensus to get changes in law that would provide a therapeutic benefit to the people who put him in power. By focusing his energy on removing the non-sensical exclusion of weight loss drug coverage in Medicare, the Senator would allow competition to work, prices would come down, and more people would be able to lose weight.
Kirsten Axelsen is a Visting Scholar with the American Enterprise Institute and is a consultant to biopharmaceutical companies.
