A KFF evaluation reveals that gross complete Medicare spending on Ozempic and different comparable medicine has elevated dramatically in recent times – though Medicare is explicitly prohibited by regulation from overlaying the medicine for weight problems.
That’s as a result of Medicare now covers the medicine, referred to as GLP-1s, for different medically accepted indications, together with to deal with diabetes. This week the Facilities for Medicare & Medicaid Providers (CMS) knowledgeable Medicare drug plans that they will cowl Wegovy, one other drug on this class, for its newly accepted use of stopping coronary heart assaults and strokes for people who find themselves overweight or chubby.
In 2022, Medicare gross complete spending reached $5.7 billion on Ozempic (semaglutide), Rybelsus (semaglutide), and Mounjaro (tirzepatide), all of which it coated for diabetes that 12 months, in keeping with just-released Medicare drug spending information. That was up from $57 million in 2018. (Gross spending doesn’t account for any rebates paid by drug producers to pharmacy profit managers, which might end in decrease internet Medicare spending.)
Gross spending on Ozempic alone elevated from $2.6 billion in 2021 to $4.6 billion in 2022, pushing it to sixth place among the many top-selling medicine in Medicare Half D that 12 months, up from tenth place the 12 months earlier than.
The truth that overlaying GLP-1s below Medicare Half D for licensed makes use of is already making a mark on complete Half D program spending could possibly be an indication of even increased spending to return as Half D plans are actually in a position to cowl Wegovy for its coronary heart well being advantages, and if new makes use of for GLP-1s are accepted.
These medicine provide substantial potential well being advantages, however the mixture of intense demand, new makes use of, and excessive costs for these remedies is prone to place large stress on Medicare spending, Half D plan prices, and premiums for Half D protection.