A KFF analysis exhibits that gross complete Medicare spending on Ozempic and different related medication has elevated dramatically in recent times – regardless that Medicare is explicitly prohibited by legislation from overlaying the medication for weight problems.
That’s as a result of Medicare now covers the medication, 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’ll cowl Wegovy, one other drug on this class, for its newly authorized use of stopping coronary heart assaults and strokes for people who find themselves overweight or obese.
In 2022, Medicare gross complete spending reached $5.7 billion on Ozempic (semaglutide), Rybelsus (semaglutide), and Mounjaro (tirzepatide), all of which it lined for diabetes that 12 months, in response to 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 medication in Medicare Half D that 12 months, up from tenth place the 12 months earlier than.
The truth that overlaying GLP-1s underneath Medicare Half D for approved 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 at the moment are in a position to cowl Wegovy for its coronary heart well being advantages, and if new makes use of for GLP-1s are authorized.
These medication provide substantial potential well being advantages, however the mixture of intense demand, new makes use of, and excessive costs for these therapies is prone to place super strain on Medicare spending, Half D plan prices, and premiums for Half D protection.
