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Medicare started protecting Ozempic in 2018.
CNN
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Medicare shelled out $5.7 billion on Ozempic and different comparable diabetes medicine in 2022, up from $57 million in 2018, in keeping with a brand new KFF evaluation.
The expensive drugs, which embrace Mounjaro and Rybelsus, have develop into tremendous in style for the remedy of diabetes and for weight reduction. However Medicare is just not allowed by legislation to cowl medicine for weight reduction.
Medicare started protecting Ozempic for folks with diabetes in 2018, with Rybelsus and Mounjaro becoming a member of in 2019 and 2022, respectively. Medicare not too long ago introduced that it could cowl Wegovy in people who find themselves overweight or chubby and have coronary heart illness after the drug gained approval from the US Meals and Drug Administration for cardiovascular advantages.
The KFF examine examined gross spending, which doesn’t have in mind any rebates paid by drug producers that will decrease Medicare spending. Knowledge on rebates is just not publicly out there.
Ozempic ranked because the sixth prime promoting remedy in Medicare Half D drug plans in 2022, up from tenth the prior yr, in keeping with KFF. Medicare spent $4.6 billion on it in 2022, in contrast with $2.6 billion the yr earlier than. The present record worth for Ozempic is $969 for a four-week provide.
The medicine’ recognition and costs might find yourself elevating prices for each the federal authorities and Medicare enrollees broadly.
“These medicine supply substantial potential well being advantages, however the mixture of intense demand, new makes use of, and excessive costs for these therapies is more likely to place large strain on Medicare spending, Half D plan prices, and premiums for Half D protection,” KFF wrote in its evaluation.
Though protection of Wegovy and comparable medicine might scale back different well being care spending, these drugs at their present costs would in all probability nonetheless price the federal authorities greater than they’d save, in keeping with a Congressional Price range Workplace evaluation launched final week.
Medicare might select Ozempic and Rybelsus for its drug negotiation program as early as 2025, KFF wrote, which might decrease spending on the drugs.