Gross Medicare Spending on Ozempic and Different GLP-1s Is Already Skyrocketing – Even Although Medicare Can not Cowl The Medication for Weight Loss

A KFF evaluation exhibits that gross whole Medicare spending on Ozempic and different comparable medication has elevated dramatically in recent times – although 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 Companies (CMS) knowledgeable Medicare drug plans that they will 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 chubby.

In 2022, Medicare gross whole spending reached $5.7 billion on Ozempic (semaglutide), Rybelsus (semaglutide), and Mounjaro (tirzepatide), all of which IT lined for diabetes that yr, 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 lead to 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 yr, up from tenth place the yr earlier than.

The truth that overlaying GLP-1s beneath Medicare Half D for approved makes use of is already making a mark on whole Half D program spending could possibly be an indication of even greater spending to come back as Half D plans at the moment are capable of cowl Wegovy for its coronary heart Health advantages, and if new makes use of for GLP-1s are authorized.

These medication provide substantial potential Health advantages, however the mixture of intense demand, new makes use of, and excessive costs for these therapies is prone to place large stress on Medicare spending, Half D plan prices, and premiums for Half D protection.