OBJECTIVES: Pharmacologic options have been available to treat obesity for over twenty years but have seen limited uptake and have struggled to obtain reimbursement by payers internationally. With this research, we aim to understand the differences in perceptions of current products used to treat weight loss and the associated differences in reimbursement between US and EU payers.

METHODS: This research began with a review of HTA assessments for obesity drugs in Germany, France, and the United Kingdom (UK). This was compared to US payer policies at large national plans and Integrated Delivery Networks (IDNs) in the United States (US). To further understand the rationale for these decisions, we conducted 45-minute interviews with 8 payers across the US and Europe. In these interviews, we also probed on what type of evidence manufacturers could develop in order to obtain more favorable reimbursement for obesity drugs in the US and Europe.

RESULTS: US payers’ rationale for limiting obesity coverage to riders were tied to the lack of direct cost offsets from currently available anti-obesity medications and the cost impact tied to widespread coverage of obesity treatments. The EU payers sampled tied their reimbursement decisions to direct outcomes data related to patients who are taking an anti-obesity drug and demonstrated a changing willingness to reimburse for obesity therapies.

CONCLUSIONS: The research suggests that reimbursement models in the UK and Europe have evolved more rapidly and are less restrictive. In the US, manufacturers will need to demonstrate near term cost offsets directly linked to anti-obesity products. Legislation may also provide the catalyst necessary to mandate coverage.