A new study is showing that providing Part D Medicare coverage for Novo Nordisk’s semaglutide to reduce cardiovascular disease risk in certain patients could cost the United States Government around $145 billion annually, according to new research published Tuesday in the Annals of Internal Medicine.
Semaglutide, which is branded as Ozempic for type 2 diabetes and Wegovy for chronic weight management, is a blockbuster GLP-1 receptor agonist that promotes insulin secretion from the pancreas and helps suppress appetite.
As of now, the Centers for Medicare and Medicaid Services (CMS) covers the therapy for diabetes but have not yet approved coverage for anti-obesity usage.
Back in November 2023, data from the Phase III SELECT study showed that a 2.4-mg Wegovy dose could significantly reduce the risk of major adverse cardiovascular events by 20% versus placebo and patients that were reated with Wegovy also saw a 28% lower risk of heart attack or myocardial infarction.
These findings led the FDA to expand Wegovy’s approval back in March of this year (2024) and allowed it’s use to decrease the likelihood of cardiovascular death, heart attack and/or stroke in overweight and obese adults with cardiovascular disease (CVD), and the CMS later announced that it would cover Wegovy for this use, for patients with body mass index of at least 27 kg/m2.
The new study found that around 3.6 million adults would be eligible for semaglutide coverage under CMS’ new guidelines. which would balloon coverage to 15.2 million adults, which could see Medicare expenditures jump by $34 billion to $145 billion if all of these new beneficiaries used semaglutide, research showed.
CBO’s analysts wrote that anti-obesity medications such as semaglutide “would cost the federal government more than it would save from reducing other healthcare spending,” leading to an “overall increase in the deficit over the next 10 years.”
Additionally, CBO has also predicted hat semaglutide would most likely be selected for Medicare drug price negotiations “within the next few years.”
