A KFF evaluation exhibits that gross whole Medicare spending on Ozempic and different comparable medication has risen dramatically in recent times — although Medicare is explicitly prohibited by legislation from protecting the weight problems medication.

That's as a result of Medicare now covers the medication, often known as GLP-1s, for different medically accepted indications, together with the remedy of diabetes. This week, the Facilities for Medicare & Medicaid Providers (CMS) notified Medicare drug plans that they’ll reimburse Wegovy, one other drug on this class, due to its lately authorised use to forestall coronary heart assaults and strokes in people who find themselves overweight or obese.

In 2022, Medicare's gross whole spending was $5.7 billion on Ozempic (semaglutide), Rybelsus (semaglutide), and Mounjaro (tirzepatide), all of which have been coated for diabetes that 12 months, in accordance with just-released Medicare drug spending knowledge. That was a rise from $57 million in 2018. (The gross spending doesn’t keep in mind any rebates paid by drug producers to pharmacy profit managers, which might lead to decrease web Medicare spending.)

Gross spending on Ozempic alone rose from $2.6 billion in 2021 to $4.6 billion in 2022, shifting it to the sixth best-selling drug in Medicare Half D that 12 months, up from tenth the 12 months earlier than.

The truth that protection of GLP-1s beneath Medicare Half D for licensed use is already impacting whole spending for the Half D program could possibly be an indication of even greater spending as Half D plans can now cowl Wegovy for its coronary heart well being advantages. and whether or not new purposes for GLP-1s are authorised.

These medication provide substantial potential well being advantages, however the mixture of excessive demand, new makes use of, and excessive costs for these therapies will probably place huge stress on Medicare spending, Half D plan prices, and premiums for Half D protection.