New weight-loss drugs could strain Medicare, policy experts warn

T.The emergence of he is very effective obesity medicine has spurred a new effort to make Medicare pay for weight-loss drugs, but a group of health policy experts are cautioning.

Even a small amount of use will likely cost Medicare a lot and, in the long run, federal insurance companies will likely increase premiums, researchers say. perspective piece New England Journal of Medicine Saturday.

Chronic medications may have fewer benefits and higher risks for the elderly, a population served by Medicare, they write.

Novo Nordisk’s Wegovy is the latest obesity drug approved in the US, and several companies are racing to develop products as well. As the drug became more popular, a bill was introduced to expand Medicare’s coverage of obesity drugs. gain momentumpharmaceutical companies, health groups, the NAACP, and members of Congress from both parties.

But “there are many reasons for caution, and many questions remain,” says Christa Beig, lead author of the paper and a doctorate in health policy. She is a student at Vanderbilt University. She said, “It would be really prudent for Congress and CMS to weigh the trade-offs and conduct a more thorough analysis of the potential impact of such a large-scale law.”

In the United States, 42% of adults age 60 and older have Estimate become obese. According to the paper, Wegovy’s net annual value is about $13,600, and if the group has 10% of his utilization, it would cost Medicare $27 billion annually. This represents 18% of his insurer’s spending on Part D (prescription drug benefits) in 2019, the most recent year for which data are available.

The researchers then considered a more conservative calculation. Medicare’s claims show that 21% of her beneficiaries have a reported diagnosis of obesity. Even with 10% utilization, that group would cost him about $14 billion a year, or 9% of his Part D spending, researchers say.

According to the researchers, in a hypothetical scenario of 100% intake by all obese older adults, the costs would exceed the total Part D budget and the total excess medical costs associated with obesity.

These numbers are close to estimates given when Biogen’s Alzheimer’s drug Aduhelm was first approved. According to STAT, if his 10% of seniors with Alzheimer’s took his Aduhelm at the original price, it would cost Medicare about $34 billion. analysis.

In the case of obesity drugs, the financial impact stems from the sheer high cost, huge population, and the need to use the drug chronically, says co-author Stacey, professor of health policy at Vanderbilt University. Dussetsina said. University Medical Center. And unlike his Aduhelm, whose efficacy is controversial, anti-obesity drugs face enormous demand as they have shown high efficacy in multiple trials.

“This study raises a very important question about the cost of these drugs,” said Juliet Kubansky, associate director of the Medicare Policy Program at the KFF, a nonprofit that analyzes health policy. says. Drugs “can pose real financial challenges to beneficiaries in the form of Medicare programs, and insurance premiums and taxpayers.”

Researchers’ concerns are in line with those of other experts. The Institute for Clinical and Economic Review, a nonprofit organization that evaluates the cost-effectiveness of medicines, Alert Last fall, it warned that the healthcare system was at risk of facing serious Wegovy restrictions.

According to ICER’s analysis, as soon as 0.1% of the target population takes Wegovy for five years, insurers and government payers may have to move funds or raise premiums.

The authors of the NEJM paper also say there is a need to better assess the benefits and risks of these drugs in older adults.

The hope for these drugs is that they help prevent downstream complications from obesity, such as diabetes and heart disease. lead author Baig said.

Older people may also experience greater risk. Medications have gastrointestinal side effects, such as nausea and diarrhea, which can affect older people more severely. Importantly, people lose muscle mass as well as fat mass, which can make older people more frail, researchers said.

John Battis, a geriatrician who treats obese and frail older adults at UNC-Chapel Hill, said the drug was “promising” but needed more data on its effects on older people. . In Wegovy’s clinical trial, 8.8% of those treated were between the ages of 65 and 75, and only 0.9% were over 75. label.

Batsis said weight loss in obese older adults can improve cardiovascular health and physical function, but is concerned about loss of muscle mass and strength. , he said, if you’re losing weight without doing resistance exercise, you risk being more susceptible to stressors and making your daily activities difficult.

Chris Gallagher, a policy consultant for the Obesity Action Coalition, a group that promotes coverage, said it was important for Medicare to pay for the drug because private plans often follow federal insurance companies. “Medicare is often viewed as the gold standard for coverage. It gives you the freedom to say,” he said.

In addition, many pharmaceutical companies are developing obesity drugs that could help bring down prices over time, Gallagher said. As time goes on, prices will drop and all obesity drugs will become more widely available to all people across the country.”

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