New weight loss drugs could cost Medicare billions of dollars each year if the program is required to cover them, public health experts wrote March 11 in the New England Journal of Medicine.
Students and professors at the Department of Health Policy at Nashville, Tenn.-based Vanderbilt University School of Medicine and the Department of Medicine at the University of Chicago wrote that Medicare is currently prohibited from covering medications specifically for weight loss. In addition to Medicare, commercial payers generally do not cover weight loss drugs.
That could change if Congress passes legislation to require Medicare to pay for weight loss drugs, the authors wrote. New semaglutide drugs, such as Wegovy and Saxenda, can cost up to 20 times more than older weight loss drugs.
If 10 percent of people with obesity covered by Medicare were prescribed a brand-name semaglutide, the drug would cost Medicare $26.8 billion annually, the authors estimated. This represents 18.5 percent of current Medicare Part D spending.
If the program covers weight loss drugs, Part D premiums will likely increase to cover the costs based on the types of medication prescribed and rate of use, the authors wrote.
"Given the potential budgetary effects of anti-obesity medications on Medicare Part D and remaining questions about their benefits among older adults, it would be prudent for Congress and the Centers for Medicare and Medicaid Services to carefully consider the potential trade-offs associated with anti obesity-medication coverage and use for Medicare beneficiaries," the authors concluded.
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