Economists warn about costs if U.S. Medicare covers new obesity drugs

In a report released Saturday (March 11), health economists say the costs of expanding US Medicare prescription drug coverage to pay for expensive new obesity drugs could be devastating. warned of potential

A top-selling diabetes drug is being repurposed as an obesity drug after clinical trials demonstrated weight loss of 20% or more. They are much more effective than older drugs, but may require lifelong use to maintain weight loss.

For example, a weekly injection of Novo Nordisk’s Wegovy costs more than US$13,000 annually in the US after rebates and discounts. Eli Lilly and Co’s Mounjaro is set to gain U.S. approval for obesity next year, and her month’s supply of diabetes has him selling for US$1,540.

Currently, Medicare is prohibited by law from paying prescriptions for anti-obesity drugs. But if the bipartisan The Treat and Reduce Obesity Act is reintroduced and passes Congress, Medicare will be forced to cover drugs for weight loss.

A health economist writing in The New England Journal of Medicine found that if 10% of Medicare beneficiaries diagnosed with obesity used prescription weight loss drugs, annual spending on Part D would be $26.8 billion on Wegovy. I estimate it will be.From Vivas Co., Ltd.

This represents almost 20% of total Medicare Part D spending in 2019, said Khrysta Baig and colleagues at the Vanderbilt University School of Medicine.

“While the burden of obesity and obesity-related conditions is undoubtedly high, the value of Medicare coverage for anti-obesity drugs remains unclear,” they said, noting that the weight loss induced by these drugs could be better long-term. He added that more research is needed to know if it leads to health outcomes in the term.

Medicare health programs cover more than 60 million Americans, most of whom are 65 and older. The authors point out that many people in the program already have long-term obesity-related health problems, unlike the younger populations typically included in clinical trials.

According to the US Centers for Disease Control and Prevention, the obesity rate in the United States is 41.5% among adults age 60 and older.

The influential Institute for Clinical and Economic Review (ICER) says Wegovy’s annual price needs to drop from US$7,500 to US$9,700 to be more cost-effective compared to lifestyle changes alone. I’m here. Even at that price point, ICER says it is not cost-effective compared to Qysmia’s generic product.

“Given the outstanding questions regarding the benefits of these drugs for Medicare beneficiaries, Congress and CMS (Centers for Medicare and Medicaid Services) should carefully consider the trade-offs before passing legislation of this magnitude. is wise.