Should employers, patients, or insurers bear the largest share of an annual $411 billion cost?
The U.S. healthcare industry is contending with the question amid the boom of GLP-1 popularity.
List prices for popular GLP-1 medicines are about $1,000 for a four-week supply. Citing high costs and demand, some employers and insurance plans have trimmed or ended GLP-1 coverage.
In mid-2024, 44% of employers with 500 or more employees offered coverage for GLP-1 obesity drugs, according to consulting firm Mercer. GLP-1 drugmakers Eli Lilly and Novo Nordisk are working to increase this percentage as they tell employers this coverage will bring long-term cost savings.
On Nov. 26, the Biden administration shared a proposal for Medicare and Medicaid to cover weight loss drugs — a proposal that would need to be finalized by the Trump administration. Currently, Medicare only covers GLP-1 medications to treat diabetes and other conditions, and about a dozen state Medicaid programs cover them for obesity.
The future of this proposal is unclear since president-elect Donald Trump has nominated Robert F. Kennedy Jr. to lead HHS, which oversees CMS. In October, Mr. Kennedy suggested providing healthy food is more effective and economical for combatting the obesity epidemic than compelling Medicare to cover weight loss drugs.
A recent study estimated that 53% of U.S. adults, about 136.8 million people, are eligible for semaglutide (Ozempic, Rybelsus and Wegovy) to treat Type 2 diabetes, obesity and/or obesity-related heart conditions. If 50% of U.S. adults with obesity took a GLP-1 medication for weight loss, it would annually cost the nation $411 billion and bankrupt Medicare, according to the Senate Committee on Health, Education, Labor and Pensions.
The White House said its proposed rule for CMS would be implemented at the same time of increased competition and the agency's annual drug price negotiations.