Weighing Cost Savings Against Safety and Regulatory Risks

In a video interview with Pharma Commerce, Hyung Heon Kim, CEO of MetaVia, describes how the current US payer ecosystem, including commercial insurers and Medicaid, exhibits a divided approach when it comes to supporting access to obesity medications. Coverage largely depends on whether obesity is accompanied by additional health complications. He explains that there are essentially two categories of patients: those who are obese without any complications and those who are overweight or obese with related conditions, such as type 2 diabetes or Metabolic Dysfunction-associated Steatohepatitis (MASH).

For patients who fall into the second category—those with complications—insurance coverage is typically available. This is because obesity-linked conditions like type 2 diabetes are recognized as serious health issues that require treatment. Payers are prepared to provide coverage in these cases, acknowledging the need for medical interventions that go beyond lifestyle changes alone.

However, for individuals who are obese but otherwise healthy, coverage remains limited. Kim highlights that the current administration does not fully recognize obesity as a disease on its own, instead viewing it as a condition that can be managed through lifestyle interventions, such as diet and exercise. This perspective means that insurance companies are less inclined to cover obesity medications for patients who do not have related health complications.

Kim suggests that this approach overlooks the broader benefits of proactive obesity treatment, which can prevent complications before they arise. While insurers and Medicaid seem prepared to handle cases with associated conditions, they are not yet structured to provide long-term affordability and access for individuals seeking preventive care solely for obesity. In essence, the payer ecosystem is ready for treatments tied to co-morbidities but lacks readiness and policy alignment for covering obesity medications in otherwise healthy patients.

He also comments on how dual-action metabolic therapies address clinical or tolerability gaps observed in first-generation GLP-1s; alternative reimbursement or value-based contracting models that could be feasible in the short term, given CMS’ decision not to finalize coverage for obesity medications in 2026; market dynamics or stakeholder misalignments that need to be resolved for next-generation weight-loss drugs to reach scale without overburdening payers (from a commercialization standpoint); and much more.

A transcript of his conversation with PC can be found below.

PC: What are the potential repercussions of telehealth companies selling GLP-1s?

Kim: I'm still being puzzled with the quality control over at those companies. These are pretty sophisticated drugs, and I'm not even sure where they're producing it. Did the FDA inspect the sites and make sure that there's quality control over it? Did they even try it on humans to make sure that it's the same drug? I don't know.

I think that's the bigger question here with those compounding companies. As for the pricing, yes, of course, they probably can have very competitive pricing because of lack of those quality controls or investment that they made before. Think about Novo Nordisk—having the semaglutide goes through five years of CV outcome. They probably spend about a billion dollars on it. They're kind of like piggybacking on that, but they need to prove that they had the same quality control and have enough data to back it up.

While this is a public health issue, yes, cheaper could work, but it could cause other damages to the patients, and it actually could cost the whole country a lot more money than having a cheaper drug.