JAMA health forum

Cost Effects of Expanding Medicare Coverage for Weight-Loss Drugs

Updated

Abstract

Among 30 million Medicare beneficiaries eligible for GLP-1 receptor agonists, 3 million are estimated to receive treatment over the next 10 years.

  • Medicare's total drug costs for GLP-1 receptor agonists are projected at $65.9 billion.
  • Health care cost offsets from reduced obesity-related comorbidities are estimated at $18.2 billion.
  • The net increased spending over 10 years is projected to be $47.7 billion.
  • Higher uptake and adherence could lead to increased health care savings, but these are expected to remain less than the additional spending on GLP-1 receptor agonists.
  • Even under moderate assumptions, net spending could still reach $8 billion, highlighting the need for further price reductions.

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Funding

Competing interests

Conflict of Interest Disclosures: Dr Huang reported grants from the National Institutes of Health during the conduct of the study. Dr Mozaffarian reported grants from the National Institutes of Health, The Rockefeller Foundation, the National Association of Chain Drug Stores Foundation, the Kaiser Permanente Fund at East Bay Community Foundation, and Google Health outside the submitted work. Dr Fendrick reported directing the University of Michigan Center for Value-Based Insurance Design; providing consulting services to AbbVie, CareFirst Blue Cross BlueShield, Centivo, Clover Health, Community Oncology Association, Covered California, Elektra Health, EmblemHealth, Employee Benefit Research Institute, Exact Sciences, GRAIL, Health[at]Scale Technologies, HealthCorum, Hygieia, Johnson & Johnson, Medtronic, MedZed, Merck, Mother Goose Health, Phathom Pharmaceuticals, Proton Intelligence, RA Capital, Sempre Health, Silver Fern Healthcare, US Department of Defense, Virginia Center for Health Innovation, Washington Health Benefit Exchange, Wellth, Yale-New Haven Health System, and Zansors; holding equity interest in Health[at]Scale Technologies, HealthCorum, Mother Goose Health, Sempre Health, Silver Fern Healthcare, Wellth, and Zansors; receiving research support from the Agency for Healthcare Research and Quality, West Health Policy Center, Arnold Ventures, National Pharmaceutical Council, Patient-Centered Outcomes Research Institute, Pharmaceutical Research and Manufacturers of America, the Robert Wood Johnson Foundation, the State of Michigan, and the Centers for Medicare & Medicaid Services; serving as co–editor in chief for the American Journal of Managed Care ; previously serving as a member of the Medicare Evidence Development & Coverage Advisory Committee; and maintaining a partnership at VBID Health. Dr Kim reported grants from the National Heart, Lung, and Blood Institute and the National Institute on Minority Health and Health Disparities during the conduct of the study. No other disclosures were reported.
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