"Last hope": Eager Germans are prepared to pay for weight-loss drug
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[July 25, 2023]
By Ludwig Burger and Maggie Fick
FRANKFURT/LONDON (Reuters) - Frustrated after countless failed diet and
exercise attempts, 41 year-old Jessica Lenth from Hamburg has started
putting money aside for a drug that she sees as a possible door to a
life without obesity.
Interviews with seven doctors and two other potential users of Wegovy
from Germany, where Novo Nordisk's weight-loss drug will become
available at the end of July, show the office administrator isn't alone.
"It's a bit like a last hope I cling to. I've just learnt the price. For
now, I'll be saving a bit of money before I try to get it," Lenth told
Reuters by telephone.
The doctors say they are hearing a similar message from hundreds of
obese or overweight patients and expect high demand for Wegovy
prescriptions even though public health insurance plans covering about
90% of Germans will not foot the bill.
The interviews suggest many patients will be prepared to pay themselves
for the weekly injection, at an initial cost of about 170 euros ($190) a
month but just over 300 euros longer term.
For the 10% of Germans with private health insurance, coverage will
depend on contract terms. Allianz says it will pay if a physician
diagnoses a medical need while Debeka said its plans exclude weight-loss
treatments.
Patient advocates and physicians welcomed the arrival of Wegovy in
Germany, where 18.5% of adults are obese, more than the European Union
average of 16%. The Robert Koch Institute for public health says
diseases linked to excess body weight pose a considerable burden on
health and social security systems.
Wegovy's launch in Germany, its third European market and the region's
largest, comes as Novo is ramping up production to meet soaring demand
in the United States, where the drug sells for as much as $1,350 a
month.
The Danish drugmaker told Reuters it would closely monitor prescriptions
in Germany to ensure that people with obesity can start and continue
treatment.
"Nevertheless, if demand is higher than expected, we cannot rule out the
possibility of supply delays and shortages in the coming months," it
said.
Novo's shares have rallied nearly 120% since Wegovy debuted in June
2021, making it Europe's second-most-valuable listed company after LVMH.
In Germany, Wegovy will be administered with the same injection pen used
in Norway and Denmark, not the one used in the United States to avoid
hitting supplies there.
A swift uptake could nevertheless further strain Novo's ability to meet
demand.
Wegovy's introduction in Germany is likely to stir the debate over what
constitutes a medical need in a nation that doctors said often sees
obesity as a "lifestyle choice" rather than a chronic disease.
Dr. Sylvia Weiner, who runs an obesity clinic at Sana Klinikum Offenbach
near Frankfurt, has fielded questions about Wegovy from several dozen
patients in the past few months and anticipates many more.
"We are really waiting for Wegovy," she said. "Patients are so desperate
in Germany that they will pay out of their pocket for the medication."
POTENTIAL IMPACT
Used alongside diet and exercise changes, Wegovy has been shown to help
obese people lose about 15% of their bodyweight.
But clinical trial data shows people regain weight after they stop
taking it. Reuters reported last week that most U.S. patients stopped
using weight-loss drugs within a year.
Dr. Karl Rheinwalt, an obesity specialist at St Franziskus-Hospital
Cologne, reckons the cost will limit uptake in Germany.
But Munich-based Dr. Thomas Horbach - who like Weiner and Rheinwalt
performs gastric bypass and other bariatric surgeries - says some of his
patients who are overweight but not diabetic already pay for Ozempic, a
diabetes drug also made by Novo, themselves.
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Doctor Thomas Horbach, specialist in
surgery, visceral surgery and nutritional medicine answers questions
on Novo Nordisk, which will start selling its hugely popular obesity
drug Wegovy in Germany later this month, during a Reuters interview
in Munich, Germany, July 17, 2023. REUTERS/Christine Uyanik/File
Photo
Using the same active ingredient at
a lower dose, Ozempic costs less per milligram of active substance
than Wegovy.
"My experience is that people will be able to pay for it out of
(their own) pocket," said Horbach. He said the ban on reimbursement
by public health schemes under a 1980s law that categorizes
weight-loss therapies as lifestyle drugs, discriminates against
people with low incomes.
Novo said prescription drugs in Germany were generally excluded from
rebate or coupon promotions.
Some specialists say the lifestyle drug classification reinforces a
widely held view that those with obesity and related conditions such
as diabetes or high blood pressure have themselves to blame.
"Patients suffer enormously from the stigma because they feel
isolated, because it's a visible disease that has been unfairly
associated with attributes such as laziness," said Dr. Juergen
Ordemann, another surgeon and head of obesity at Berlin's Vivantes
hospital chain.
Without public health insurance for obesity drugs, and very limited
payments for obesity-specific psychotherapy, treatment in Germany
often means surgery for the most severe cases, with a BMI of around
50.
DIET AND EXERCISE
All the doctors interviewed by Reuters said they intend to prescribe
Wegovy alongside structured diet and exercise programs.
Many worried that supplies would be further strained by non-obese
people seeking "vanity" prescriptions - a concern reflected in a
Novo statement last week saying physicians should "prescribe
responsibly".
Doctors say they will primarily consider Wegovy for patients who are
at the early stages of obesity, with a BMI of around 30 or slightly
higher, and not recommended for surgery.
Severely affected patients would still require surgery but they
could use the drug to prepare for their procedures and help them
maintain a lower weight afterwards.
Michael Wirtz, a civil engineering project manager from Winsen an
der Luhe in Lower Saxony, had gastric bypass surgery in 2011 that
helped him lose 70 kg.
He has since regained 25 kg, however, and is considering Wegovy
alongside lifestyle changes.
"Without it, I would probably have to think about changing my job to
ease the stress level, but that would of course mean a lower
income," said Wirtz, adding that he might cancel some subscriptions
to help afford the cost.
Irina Ernstberger, a 66 year-old retiree, said she considers Wegovy
a fallback option after she lost weight to well below the obesity
threshold with the help of Ozempic.
Speaking to Reuters at her house in Munich, Ernstberger said she is
on the right track, having maintained her weight for three months
even after getting off Ozempic, which she paid for herself.
The investment was worth it.
"Sure, it costs a lot, not just the medicine itself, but also a
completely new wardrobe. But buying new clothes was fun," she said.
($1 = 0.8984 euros)
(Reporting by Ludwig Burger in Frankfurt and Maggie Fick in London,
Patricia Weiss in Frankfurt; Editing by Josephine Mason and
Catherine Evans in London)
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