THCB

Dr. Aetna Will See You Now

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 CostsHow 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.

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Lu
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Lu

This is my first time ever giving a review, and it’s because I have never seen anything like this. Honestly, I just want people to know about this and maybe something can come out of it. I have a surgery scheduled for next month. Prior to switching to Aetna, I was covered under my parents’ health insurance. Since I recently turned 26, I was required to subscribe to my university’s plan. I have scheduled and attended a number of appointments in the past month to diagnose a problem that I had been experiencing. I had spoken to a representative of… Read more »

Marian
Guest

Great delivery. Outstanding arguments. Keep up the good work.

Review my website – national flood forum (Marian)

Al Lewis
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Al Lewis

JAMA just slammed these drugs too. About a month after we did but better late than never http://news.yahoo.com/caution-urged-over-weight-loss-drugs-214457769.html

Lia Spiliotes
Guest

Well, well, well…this gives Aetna’s competitors a chance to make hay while the sun shines down on this great gaffe, a gift of Aetna to them. If they’re smart, they’ll get cracking.

MedicalQuack
Guest

Aetna has been known to do some strange things like the contest pilot about taking your meds..run a lottery to get folks all excited and earn a few bucks..I think it took a dive and the ridiculous efforts to “dummy down” patients with games that are portals that scrape data… http://ducknetweb.blogspot.com/2011/10/insurer-software-games-continue-to-dumb.html Its all about the math models for profit usually at the source of some of the stuff you see out there today and I did a very popular post about it about quantitated justification for things that are just not true. This is going to get bigger as we… Read more »

RocK8Doc
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RocK8Doc

It’s absurd to blame Capitalism for what the Insurance companies are doing. It’s at best Crony Capitalist system.

It’s not just Humana.

Look at Concentra, a subsidiary of Humana, they are rapidly expanding in delivery of Immediate care both in Workers Compensation and Group Health.

They also have spread their tentacles in utilization review….

Sam I am
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Sam I am

This is a fully baked idea by Aetna and I can’t believe they will make even a few pennies per share for their efforts. Why risk your reputation at all for something that doesn’t make sense at all.

Al Lewis
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Al Lewis

I’m not sure we can blame ACA for Aetna’s corrupt bargain. By the way, someone offline commented to me that it is possible that these drugs work and that doctors simply aren’t willing to prescribe them. We can’t rule that out (though the side effects are pretty apparent) so I wanted to give airtime to that viewpoint. (My suspicion is that if a drug for a condition like obesity worked, news of that success would go viral.) And that doesnt’ excuse Aetna’s unconscionable willingness to let its customers be the guinea pigs on their self-insured lives while not doing this… Read more »

Gary Glissman
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Gary Glissman

This is another blatant example of the consequences of allowing health care to be delivered under a capitalistic economic model. It simply cannot continue this way or we will see even more distasteful/harmful/inappropriate developments like this. As if we haven’t seen enough of them already. What amazes me is that so many very intelligent people in this country understand what’s happening but that awareness and discussion and exposure has not been sufficient to get even a small rise out of Washington, much less needed action. What does that tell you about our political system in its current state? And that… Read more »

Vik Khanna
Guest

Gary: you are 100% correct that it all goes back to the political process. Our political system is broken, and its fractured processes have delivered to us a broken healthcare system. Not only is it impossible to find an hones politician, finding one who can speak about healthcare in something other than carefully scripted, but consistently moronic talking points (crafted by whichever interest group they favor), is equally impossible.

Kathy Cash
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Kathy Cash

This is a truly dismaying move. It’s no surprise to most people that Big Pharma has become too powerful and wields an inappropriate influence over the medical profession, but now that one company is literally climbing into bed with an insurance carrier, we have reached an all-time low. It’s just one more example of how ACA does NOT address the real problems in our health care system. The pharmaceutical industry is not addressed at all in the law and while insurance companies were certainly impacted by the law, rather than making their policies more flexible and affordable, the system has… Read more »

Aurthur
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Aurthur

Are you suggesting that The Act does not Protect the Patient or make Care more Affordable? How could the system be more “unnavigable” when we have so many more Navigators? I am shocked; shocked I tell you.

Mike
Guest
Mike

Of all the things that Aetna could be working on to improve their member’s health this is a really odd initiative. For sure the answer to why they are doing this can be found by following the money. As ACA turns these companies into highly regulated utilities I suppose they have to find other ways to generate revenue.

Marissa
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Marissa

Aetna should get in a lot of trouble for this. It’s wrong on so many dimensions. Someone at Aetna has to have a side deal going with the drug companies because otherwise you’d have to wonder about the busiiness judgment of whoever came up with this idea. I predict in a week we’ll see this on Huffpost or some other national news site. Their competitors should be all over this too.