If all newly eligible beneficiaries receive semaglutide, maximum Medicare spending could be $34 to $145 billion annually
By Elana Gotkine HealthDay Reporter
MONDAY, Aug. 26, 2024 (HealthDay News) — Increases in eligibility for semaglutide are discussed in a research letter published online Aug. 27 in the Annals of Internal Medicine.
After the Semaglutide Effects on Heart Disease and Stroke in Patients With Overweight or Obesity trial showed that semaglutide reduced cardiovascular events in certain patients without diabetes, Medicare announced it would allow Part D to cover semaglutide. Alexander Chaitoff, M.D., M.P.H., from Brigham and Women’s Hospital in Boston, and colleagues identified Medicare beneficiaries most likely to be newly eligible for semaglutide and estimated the maximum costs to Part D.
The researchers found that overall, 5,111 Medicare-eligible adults (about 61 percent) with complete data had a body mass index (BMI) of 27 kg/m2 or more. After weighting, 3.6 million people (14.2 percent) were highly likely to be newly eligible for semaglutide; this number could increase to 15.2 million people (60.9 percent) using more liberal definitions of established cardiovascular disease (CVD). Maximum Medicare spending could be an additional $34 to $145 billion annually if all newly eligible beneficiaries received semaglutide. The demographics of newly eligible patients will depend on the definition of established CVD, but younger, generally healthier, female Medicare beneficiaries are likely to remain ineligible.
“Although approximately one in seven Medicare beneficiaries with elevated BMI is likely to be newly eligible for semaglutide, the majority will remain ineligible if a narrow definition of established CVD is used by Part D plans,” the authors write.
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