Medicare coverage of semaglutide would be costly
Covering semaglutide for patients who are overweight and have cardiovascular disease could cost Medicare an additional $34 to $145 billion annually, researchers estimated.
As many as one in seven Medicare beneficiaries would be potentially eligible to take semaglutide as a weight-loss drug, an economic analysis found.
Researchers used data on Medicare beneficiaries in the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2020, including on their medication use, clinical examinations, laboratory data, and diabetes diagnoses. They considered scenarios in which any patient with a body mass index (BMI) of 27 kg/m2 or more and diabetes would receive semaglutide and in which different definitions of cardiovascular disease (CVD) risk were used to determine semaglutide eligibility. Results were published as a letter in Annals of Internal Medicine on Aug. 27.
Overall, approximately 61% of Medicare-eligible adults with complete data in NHANES had a BMI of 27 kg/m2 or more. In weighted analyses, the researchers calculated that 3.6 million people (14.2%) were highly likely to be eligible for semaglutide coverage. More liberal definitions of CVD could increase this to 15.2 million people (60.9%), which could cost Medicare an additional $34 to $145 billion annually.
“Weight control has benefits for patients with elevated BMI, so the definition of established CVD used by Part D plans for coverage of semaglutide could have outsized public health implications,” said the study authors. However, wide use of semaglutide in Medicare patients could also cause “more than $10 billion in new annual federal spending, potentially making it the costliest drug to Medicare Part D,” the authors added, calling for policy solutions to deal with the budgetary impacts as semaglutide access is expanded.