Pricing on obesity medications must be addressed

The dominant intervention for patients presenting with severe and complicated obesity remains surgery, the Irish Thoracic Society 2025 Annual Scientific Meeting was told by a leading expert in the field.

“There’s no equivocation about that,” Prof Francis Finucane, Consultant Endocrinologist, University Hospital Galway, and Professor of Medicine, University of Galway, informed attendees.

During a talk entitled, ‘A two-pronged approach to obesity’, Prof Finucane explained that surgery was safe and more effective “than even the best drugs still”.

“And importantly, it is very cost-effective, especially against drug therapy,” he said.

However, Prof Finucane added that new medications  have “totally changed our thresholds for certain interventions, the ambitions we have for patients, and their expectations”.  

Regarding drug therapy, Prof Finucane explained that progress had been slow for many years, until the recent development of GLP-1 receptor agonists, which have significantly changed treatment options and patient outcomes.

“GLP-1 is a ubiquitous molecule in the sense that it is produced all along the gastrointestinal tract,” he said.

“It has numerous actions on lots of different tissues.”

However, Prof Finucane added that these medications’ actions are predominaantly felt in the centres in the brain that influence appetite, satiety, and reward centres associated with eating.

“That’s how these drugs work. We talk about ‘weight loss’ drugs, but really we want to reframe that,” he said. “These aren’t so much ‘weight loss’ drugs as ‘eat less’ drugs.”

He added that the medications can have side-effects, including pancreatitis, which occurs in approximately one in 500 patients, gallbladder disease in nearly 4 per cent, and more common issues such as constipation, vomiting, and nausea. “There are a lot of things we need to think about when we prescribe them.”

While they can be very effective, Prof Finucane stressed that there is a variation in the response of patients to the medication in terms of weight loss.

“It is not a reflection of their intelligence or motivation – it’s a reflection of their biology,” he said.

“We don’t know and the big challenge is trying to figure out the variation in response to these drugs.”

Answering this question would save patients from “futile treatment” and the health service considerable funds.

“There are a significant minority, even with the best drugs, who don’t lose any weight,” he said.

Prof Finucane said people with obesity who need treatment “ought to be getting the drugs provided by the healthcare system, according to the same rules we provide drugs for other conditions”.

“Why is that not happening in Ireland? The biggest challenge we face is that our patients can’t afford these drugs. I might see 20 patients on a morning, and we might offer 10 of those patients obesity medications, and half of them will say ‘I can’t afford them’. It is heartbreaking. And I think it is unique in medicine, where you have a situation where you’d like to offer a patient a safe, efficacious treatment and you can’t because they can’t pay for it. That is a huge challenge.”

He said that these medications are too expensive and this was “a nettle that needed to be grasped” by society.  “We’re aligned with drug companies 99 per cent of the time, but when it comes to the cost of medications, our interests and our patients’ interests are diametrically opposed to the commercial interests of drug companies, which by law have to make a profit and have to maximise the return for their shareholders.”

He said that companies need to be encouraged to “do the right thing by society” in terms of pricing. 

Prof Finucane also urged Ireland to adopt a similar approach to unhealthy, ultra-processed foods as it did with smoking, describing the recent series of Lancet articles on obesity as a “blueprint for government action”.

“We have to emulate what you have done over the last 30 years in respiratory public health. We are way behind,” he said. “Voluntary codes around the marketing and advertising of unhealthy food to children are toothless, unenforceable, and tend to go around in circles…. There is complete policy inertia when it comes to obesity and yet we think we are doing great.”

Prof Finucane highlighted the work of the new HSE National Clinical Programme for Obesity in providing a positive framework of care for patients with severe and complicated obesity.

He also praised the 2013 Healthy Ireland strategy.

“Then by 2015/2016, they had the obesity policy and action plan, and it was clear that industry had time to get its ducks in a row and influence that very strongly.”