Weight loss, drug prices, abortion and prescribed psychedelics: Expect reckonings in 2024
This year has been a major turning point in American health care and patients can anticipate several major developments in the new year.
Notable developments in 2023 included the end of the COVID-19 public health emergency, the beginning of a CRISPR “revolution” and a new reckoning with drug prices that could change the landscape of the U.S. health care system for decades to come.
Health care officials expect 2024 to bring a wave of innovation and change in medicine, treatment and public health.
As the presidential election kicks into gear, here are four of the biggest health stories to watch for in 2024.
A year of long-awaited weight loss
This month Oprah Winfrey announced that she is taking weight-loss medication along with exercise and careful eating to finally "quiet the food noise" and overcome the sense of shame she's long had about being overweight.
Many think 2024 could be the year more people have the tools to follow through on New Year's resolutions about weight loss. If they can afford them and manage to stick with them, people can turn to a new generation of remarkably effective weight-loss drugs, also called GLP-1s, which offer the potential for substantial weight loss.
Wegovy, which was approved in 2021, and Zepbound, which got the nod from the U.S. Food and Drug Administration in 2023, are the most effective publically available weight-loss drugs ever made.
Wegovy has been shown to help people shed as much as 16% of their body weight, in combination with exercise and diet. Zepbound's highest dose, along with lifestyle changes, has helped people lose as much as 27% of their body weight over 18 months.
Although long-term data isn't available, these drugs also appear to be the safest to date. A large number of people suffer from gastrointestinal distress on the medications, including vomiting, nausea and diarrhea; but more serious side effects, like those that sidelined previous weight-loss drugs, have been extremely rare. Wegovy also appears to reduce the risk of a repeat heart attack or stroke for people with pre-existing disease.
So far, both drugs have been hard for patients to access. Suppliers have had trouble making enough of the meds to meet skyrocketing demand. And many insurers haven't covered the cost of the drugs, which can run from about $1,000 to over $1,300 a month.
Paying for them should become easier in 2024, as supplies crank up and insurers could bow to market pressure and cover more of the cost.
Also in the new year, there are more GLP-1 drugs on the way and in more forms. Both Wegovy and Zepbound are delivered as weekly shots. Pill versions are under development as are other medications, some of which could help people lose even more weight.
It's unclear whether drug companies will be able to do anything about the side effects, though. It's also hard to tell how soon competition might help bring down prices.
There's a major unknown factor with these drugs, which could become better understood in the coming years. Experts can't say if people will be able to keep the weight off if they don't make lifestyle changes and stop taking the drugs.
Right now, the companies say these medications need to be taken for life, just like drugs for high blood pressure or cholesterol.Several doctors in the field said drug developers should come up with cheaper alternatives that allow people to maintain a lower weight with fewer side effects, perhaps by taking a much smaller dose of the same drug or an off-patent version.
Mental health and psychedelics
In 2023, mental health issues becameamongthe nation's most deadly, costly and pervasive health crises.
Nearly 50,000 people died by suicide in 2022 and 5.8 million emergency department visits were linked to mental, behavioral and neurodevelopmental disorders in 2021, according to the Centers for Disease Control and Prevention. The agency has yet to release preliminary data from 2023.
The Biden administration made mental health a priority by expanding the national 988 Suicide & Crisis Lifeline, funding mental health resources and programs at schools, and targeting sources causing poor mental health including social media and loneliness.
While health agencies made progress in providing support in recent years, experts say there isn't enough funding or programming in place to address the growing need. The dearth of remedies has also paved the way for an unsuspecting class of drugs: Psychedelics.
MDMA, a party drug commonly known as "ecstasy," could win approval for legal distribution in 2024, as a treatment for post-traumatic stress disorder.
Another psychedelic, a ketamine derivative eskatemine, sold as Spravato, was approved in 2019 to treat depression, but it is being treated like a conventional therapy that must be dosed regularly, not like a psychedelic that provides a long-lasting learning experience, said Matthew Johnson, an expert in psychedelics at Johns Hopkins University.
MDMA (midomafetamine capsules) would be different, as the first true psychedelic to win FDA approval.
In a late-stage trial of patients with moderate or severe post-traumatic stress disorder, close to 90% showed clinically significant improvements four months after three treatments with MDMA and more than 70% no longer met the criteria for having the disorder, which represented "really impressive results," according to Matthew Johnson, an expert in psychedelics at Johns Hopkins University in Maryland.
Psilocybin, known colloquially as "magic mushrooms," is also working its way through the federal approval process, but it likely won't come up before officials for another year, Johnson said.
Psychedelics are something to keep an eye on in the future, as they're being used to treat an array of mental health issues: eskatimine for depression, MDMA for PTSD and psilocybin for addiction. Johnson said his research suggests that psychedelics will probably have a generalizable benefit across many mental health challenges in the years to come.
However, psychedelic experts like Johnson worry that approval of these medications could open the floodgates for irresponsible use of the drugs. Careful administration of psychedelics involves undergoing psychotherapy as well as taking medication, he noted.
The potential harms of psychedelic use can include psychosis and other hallucination-related disorders, memory impairment, sleep disruption and short-term depression, according to research. Doctors often warn people with a personal or family history of schizophrenia to stay away from these drugs.
Esketamine comes with a warning from the FDA and a requirement that it be administered in a health care setting where patients can be under observation for at least two hours after taking it. The actor Matthew Perry, who starred in the popular 90s sitcom "Friends," died from the acute effects of ketamine, along with other contributing factors.
Under supervision, some psychedelics have dramatically transformed people's mental health. Johnson hopes the public attention that would come with FDA approval would also mean more people will be helped by psychedelics and use of them in a medical setting will become "normalized."
Big Pharma navigates new price limits
Once the calendar flips to January, consumers will begin to learn more about new pricing for their prescription drugs.
Pharmaceutical companies typically roll out price increases for hundreds of drugs in the first few weeks of the year. But new constraints on drug prices could limit increases.
The federal climate and health bill, called the Inflation Reduction Act, restricts how much companies can hike Medicare drug prices for older adults. If drug companies increase prices above the rate of inflation, they must pay Medicare a rebate.
Those inflation penalties have already lowered prices on some drugs administered at hospitals, clinics and doctors' offices. In December, Medicare officials released a preliminary list of 48 drugs including blood thinners, antibiotics and chemotherapy medicines that could be subject to an inflation penalty in January. If those penalties were levied, Medicare would recoup money from drug companies and enrollees would likely pay lower cost-sharing for these drugs.
The federal law will also find new ways to pressure drug companies' prices. For the first time, the federal government has empowered Medicare to negotiate lower drug prices.
The Biden administration named the first 10 drugs the federal government plans to negotiate but the price changes on those diabetes, heart disease and cancer drugs won’t take effect until 2026. Over the next two years, another 30 drugs will be selected for negotiated prices beginning in 2027 and 2028.
Drug companies and their industry allies have challenged the process, filing several lawsuits aimed at halting price negotiations.
While consumers won't see discounts from negotiated prices until 2026, other provisions promise more immediate savings. For example, in 2025, enrollees in Medicare's Part D drug plans will have their out-of-pocket expenses for prescriptions capped at $2,000 per year.
Other factors could influence prices in 2024, as Congress continues to scrutinize the role drug pricing middlemen, called pharmacy benefit managers, play in the prescription drug market.
The U.S. House of Representatives passed health care price transparency legislation that would ban pharmacy benefit managers from Medicaid spread pricing. This form of pricing occurs when pharmacy middlemen charge more than what they pay pharmacies for prescriptions. Senate committees also are working on legislation to bolster oversight of pharmacy benefit manager practices.
As the Inflation Reduction Act limits annual price increases for seniors and political pressure builds on drug-pricing middlemen, some analysts say pharmaceutical companies might try to launch new drugs at ever-higher prices. This could include Eli Lilly's donanemab, a drug that slowed cognitive decline in people in the early stages of Alzheimer's disease. The FDA will review the drug by the end of March and it could hit the market shortly after.
Supreme Court mifepristone case, abortion access on the ballot
The fate of a drug used to terminate pregnancies is now before the U.S. Supreme Court in two new cases, bringing a renewed focus to abortion access in the wake of the Dobbs ruling that overturned Roe v. Wade.
In December, the Supreme Court agreed to hear cases that rolled back access to mifepristone, an oral drug that is used jointly with another drug, misoprostol, to end a pregnancy in the first trimester. Medication abortions are the most common form of abortion in the U.S.
The Food and Drug Administration approved mifepristone, which patients across the U.S. can access through telemedicine and the U.S. mail. In 2016, the FDA determined that only one doctor's visit, instead of three, is necessary for a patient to be prescribed mifepristone.
The high court’s ruling, expected by late June, could significantly hinder access to abortions through telemedicine and the mail, especially for people in rural areas and those who have limited ability to travel to an abortion clinic. The ruling also has implications for people seeking abortion in states where it is legal.
The 2024 ruling could restrict access beyond the Supreme Court’s 2022 decision to overturn Roe v. Wade, the 1973 case that affirmed a constitutional right to abortion. The Dobbs ruling in 2022 resulted in several Republican-controlled states effectively cutting off abortion.
Voters this year began weighing in on new measures that would limit or expand access. In November, abortion rights activists scored key victories in Ohio, a Republican-leaning state where voters enshrined abortion access in the state constitution, and in deep-red Kentucky, where Democratic Gov. Andy Beshear won reelection championing abortion rights.
In Texas, Kate Cox, a Dallas-area mother of two, challenged her state’s strict anti-abortion laws in December after she learned that her fetus at 20 weeks had a deadly genetic condition. The Texas Supreme Court prohibited her from terminating her pregnancy based on state laws that restrict doctors' rights to perform abortions. Cox opted to travel outside of Texas to end the pregnancy.
Doctors who provide abortions under these circumstances can be sentenced to life in prison under state law. Private citizens can also sue any person who helps another person someone obtain an abortion. Restrictions like these have resulted in a brain drain of doctors leaving or skipping out on jobs in Texas and other states because of the limits on medical practice.
The 2024 presidential election is likely to touch on abortion access, and it's likely candidates will cite Cox’s case and others as they talk about the country's future.
This article originally appeared on Cincinnati Enquirer: Weight loss, abortion, drug prices, psychedelics: Hot topics of 2024
