The ever-blurring line between the practice of medicine and the business of profiting from unhealthy lifestyles was crossed again Wednesday, as Aetna announced a collaboration with two pharmaceutical companies to pitch their prescription weight loss drugs to selected Aetna members.
This announcement crosses multiple lines, not just one. First, no insurer has ever announced that it would openly direct a specific class of members to use particular proprietary drugs. Disease management (DM) programs rarely recommend specific drugs, and certainly in the exceptionally rare instances when they do, the recommendations are not specific brand-name drugs (in this case, Arena’s Belviq and Vivus’s Qsymia).
Instead, DM focuses on improving compliance with existing drug regimens, and DM firms encourage members “talk to their doctor” about changing therapies. While DM companies shy away from directing patients to specific products, physicians and pharmacists have discretion to discuss the full range of covered generic and brand products with patients, in order to optimize therapy and close algorithm-identified care gaps.
Second, there are no generally accepted care algorithms (other than those created by the manufacturers of those products) for these two drugs in the treatment of obesity. So there is no “gap” to fill. If there were an accepted protocol, these drugs might be blockbusters but instead Belviq’s recent quarterly sales were an anemic $4.8-million, “well below even reduced Wall Street expectations,” while QSymia sales are “flailing” at $6.4-million for the same period.
Obese people and their physicians seem to be avoiding these drugs in droves. Regardless of what Aetna and the manufacturers believe about their effectiveness, or whatever promotional deal they’ve cut, market reaction is telling a different story, and unfortunately for Aetna, Vivus, and Arena we live in a market economy.
Third, these members (the press release is careful not to refer to them as “patients”) aren’t even sick. They are obese. It is controversial and not at all clear that obesity is a disease. This question has been debated on THCB and elsewhere, and is far from settled. Aetna itself in this press release does not refer to obesity as a disease but rather a risk factor.
Finally, because it’s likely that not one obese person has ever called Aetna to ask: “What specific name-brand flailing drug from manufacturers out of favor with financial markets would you recommend for me?” Aetna isn’t just sitting by the phone. They are providing “outreach” to those members, combined with a small incentive of a free app, to convince people to take these drugs.
In an era when most insurers are “counterdetailing” to provide education to and incentives for increasing use of generics, Aetna is, uniquely, helping two pharmaceutical companies sell their hapless name-brand products to its members and detail them to its network physicians.
It’s possible that maybe Aetna should get the benefit of the doubt, seeing as they are “putting their money where their mouth is,” and betting that insured members will save them more than enough money in avoided medical events to offset the considerable cost of these drugs. However, it is exactly the opposite situation.
As is often the case with insurer-sponsored wellness programs aimed at the not-really-sick population, Aetna is offering its self-insured customers these drug advocacy programs for their employees, but not offering them to their own fully insured members. (Presumably the drugs are covered, as are most FDA-approved drugs, but Aetna is not actively advocating them to fully insured people, we don’t know their position in formulary tiers.)
Others may also find additional fodder in this press release to support a hypothesis that Aetna knows nothing about weight control, such as a belief completely unsupported by evidence that behavior modification is effective against obesity, failure to understand the difference between short-term weight loss and long-term weight loss maintenance, over-reliance on anecdotal outcomes, and insufficient disclosure of product side effects.
The nasty outcomes in clinical trials included a 20% incidence rate of paresthesia for Qsymia users and 5% incidence of high blood pressure and 12% incidence of back pain in Belviq users.
However, misunderstanding the basics of study design and weight control — along with any consequences of their actions such as any potential liability if these drugs turn out to be another fen-phen (phentermine of fen-phen fame is one of the two active ingredients in Qsymia) — is not the lead here. The lead here is that Aetna is playing doctor with a license they don’t have, pushing drugs that no one seems to want on people who aren’t actually sick…without even taking the financial consequences of its own actions but rather foisting those consequences instead on the very same employer customers whose financial risks and whose employees’ health they are supposed to be protecting.
Al Lewis is the author of Why Nobody Believes the Numbers, co-author of Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care, and president of the Disease Management Purchasing Consortium.
Vik Khanna is a St. Louis-based independent health consultant with extensive experience in managed care and wellness. An iconoclast to the core, he is the author of the Khanna On Health Blog. He is also the Wellness Editor-At-Large for THCB.
Vik and Al are the first authors in THCB’s new e-publishing venture. Their book, Surviving Workplace Wellness…With Your Dignity, Finances and (Major) Organs Intact, will be released soon. Vik’s solo e-book, Your Personal Affordable Care Act: Making Yourself Scarce In The Dysfunctional US Healthcare System will be released simultaneously. Pre-orders are being taken now at this link, where you can also sign up to receive additional information.