Economists warn of costs if US Medicare takes on new anti-obesity drugs

By Nancy Lapid

(Reuters) – The cost of expanding US Medicare’s prescription drug coverage to pay for expensive new anti-obesity drugs could be catastrophic, health economists warned in a report published on Saturday.

Successful diabetes drugs have been repurposed to treat obesity after clinical trials showed weight loss of more than 20%. Although they are far more effective than older drugs, lifelong use may be required to maintain the weight lost.

For example, once-a-week injections of Wegovy from Novo Nordisk cost more than $13,000 a year in the US after discounts and discounts. Eli Lilly and Co’s Mounjaro, which is expected to receive US obesity approval next year, retails for $1,540 for a month’s supply of diabetes.

Currently, Medicare is prohibited by law from paying for obesity prescriptions. But should the bipartisan The Treat and Reduce Obesity Act be reinstated and passed by Congress, Medicare will be forced to cover weight-loss drugs.

Health economists writing in the New England Journal of Medicine estimate that if 10% of Medicare beneficiaries with obesity diagnoses used prescription drugs to lose weight, annual spending on Part D would be $26.8 billion for Wegovy, compared at $1.32 billion for a generic version of Vivus Inc’s older Qysmia.

That accounts for almost 20% of total Medicare Part D spending in 2019, said Khrysta Baig of Vanderbilt University School of Medicine and colleagues.

“The burden of obesity and obesity-related disorders is undoubtedly high, but the value of Medicare coverage for anti-obesity drugs remains unclear,” they said, adding that more research is needed to know if one is affected by these drugs induced weight loss leads to a better long-term effect. long-term health outcomes.

The Medicare health program covers more than 60 million Americans, most of them over the age of 65. The authors note that many people in the program have already experienced the health problems associated with long-term obesity, in contrast to younger populations who typically participate in clinical trials.

According to the Centers for Disease Control and Prevention, the prevalence of obesity in the United States is 41.5% among adults age 60 and older.

The influential Institute for Clinical and Economic Review (ICER) has said that Wegovy’s annual price would need to drop to $7,500 to $9,700 for it to be cost-effective compared to a lifestyle change alone. Even at that price point, it still wouldn’t be cost-effective compared to generic Qysmia, ICER said.

“Given the unanswered questions about the benefits of these drugs for Medicare beneficiaries, it would be prudent for Congress and CMS (the Centers for Medicare & Medicaid Services) to consider compromises before passing legislation of this magnitude,” Baig said.

(Reporting by Nancy Lapid; Editing by Bill Berkrot)


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