Medicare Spending on Ozempic and Similar Diabetes Drugs Jumps 100 Times: Report

In this photo illustration, boxes of the diabetes drug Ozempic rest on a pharmacy counter in Los Angeles on April 17, 2023. (Mario Tama/Getty Images)

Medicare spending on weight-loss and diabetes drugs like Ozempic and Rybelsus has “skyrocketed” over the past four years, potentially putting “tremendous pressure” on the program, according to a recent report.

GLP-1 drugs were initially developed to treat type 2 diabetes. However, they are being used for other purposes as well, like treating obesity and reducing the risk of certain adverse cardiovascular events. Medicare is prohibited from covering drugs for weight loss. But Medicare Part D plans can cover GLP-1 drugs for other purposes, including diabetes. As of 2022, Part D covered three GLP-1s for diabetes—Ozempic, approved in December 2017; Rybelsus in September 2019; and Mounjaro in May 2022.

Total gross Medicare spending on these GLP-1 drugs “has skyrocketed in recent years, rising from $57 million in 2018 to $5.7 billion in 2022,” health policy research group KFF said in a March 22 report. This is a 100 times jump in spending in just four years.

Between 2021 and 2022, Part D spending on Ozempic alone “increased substantially.” In 2021, it was in 10th place among the ten top-selling Part D drugs, with gross spending of $2.6 billion. A year later, in 2022, Ozempic jumped to the 6th spot, spending $4.6 billion. Total gross spending under Medicare Part D was $240 billion in 2022, with Ozempic accounting for two percent of this amount.

“The fact that covering GLP-1s under Medicare Part D for authorized uses is already making a mark on total Part D program spending could be a sign of even higher spending to come as Part D plans are now able to cover Wegovy (a GLP-1 drug) for its heart health benefits,” KFF said.

“The combination of intense demand, new uses, and high prices for these treatments is likely to place tremendous pressure on Medicare spending, Part D plan costs, and premiums for Part D coverage.” The annual cost of GLP-1 drugs is north of $11,000 in the United States.

Related Stories

Sea Moss–Trending Now for Brain Health and Weight-Loss to Virility

3/26/2024

Medicare to Cover Weight-Loss Drug Wegovy for Heart Disease Patients

3/22/2024

The high costs and popularity of these drugs can end up raising costs for Medicare enrollees and the federal government.

A KFF post from last year cited a study from The New England Journal of Medicine to point out that if just ten percent of obese Medicare beneficiaries were to use Wegovy, the annual cost of Medicare would rise by $13.6 billion to $26.8 billion.

In a March 20 report, the Congressional Budget Office (CBO) pointed out that at their current prices, anti-obesity medications (AOM) “would cost the federal government more than it would save from reducing other health care spending.”

And this will result in an overall increase in the healthcare deficit over the next decade, it warned. Medicare coverage of AOMs would lead to “considerable demand” for these medications by enrollees.

“CBO is not aware of empirical evidence that directly links the use of AOMs to reductions in other health care spending,” the report stated.

The organization’s analysis of simulation models showed that the use of AOM drugs in Medicare would reduce the program’s spending on other types of healthcare, likely negatively affecting people who seek such care.

GLP-1 Drug Side Effects

The KFF report comes as the Medicare program will start covering Wegovy, provided the medication is prescribed for reducing the risk of stroke and heart attacks.

Earlier this month, the U.S. Food and Drug Administration (FDA) approved Wegovy for these purposes among obese or overweight adults who do not suffer from diabetes.

The U.S. Centers for Medicare & Medicaid Services (CMS) “has issued guidance to Medicare Part D plans stating that anti-obesity medications that receive FDA approval for an additional medically accepted indication can be considered a Part D drug for that specific use,” an agency spokesperson told Reuters.

The Wegovy approval comes as a judicial panel last month centralized several lawsuits filed against weight loss drugs like Ozempic and Wegovy.

The lawsuits claimed that the companies failed to adequately warn users and doctors about the dangerous potential gastrointestinal side effects of the drug. Plaintiffs allege they suffered gastrointestinal injuries from using the drugs, including gastroparesis, a condition in which a person’s stomach does not empty properly.

GLP-1 RA drugs mimic a natural human glucagon-like peptide (GLP-1) in order to slow down the passing of food through the stomach.

Individuals who suffer from gastroparesis can experience dehydration from repeated vomiting, difficulty in controlling blood sugar levels, and malnutrition due to poor nutrient absorption—consequences that can be life-threatening.

Meanwhile, the FDA revealed in January that it was investigating whether weight-loss drugs like Ozempic, Wegovy, and Mounjaro were linked to potential side effects like aspiration, suicidal ideation, and hair loss. Aspiration is a condition in which something that is swallowed enters the airway or lungs.

In an interview with The Epoch Times. Rik Mehta, a former FDA adviser who fought against counterfeit medicine, pointed out that GLP-1 drugs “carry a high degree of risks associated with them.” As such, “patients should really think about whether the benefit-risk is appropriate for them and discuss this with their prescriber before starting these products.”

“Both the FDA and European regulators have identified a signal related to increased psychiatric, adverse effects associated with Ozempic. So it will be interesting to see what regulators end up coming back and whether this product will stay on the market.”