The semaglutide camel’s nose under the Medicare tent
Obesity is a risk factor for cancer, heart disease stroke and diabetes. Thus, drugs like semaglutides (Wegovy, Ozempic) don’t just reduce weight in the obese, they also reduce risk of cancer, heart disease, stroke and diabetes, which are huge health care burdens. It’s good to see that Medicare is finally coming to grips with this obvious fact:
“On March 8, 2024, FDA approved Wegovy (semaglutide) to treat cardiovascular disease risks — heart attack, stroke, and death — for obese or overweight adults with a history of cardiovascular disease, making it the first anti-obesity medication (AOM) to obtain such approval. Studies show that semaglutide reduces heart disease risks when accompanied by blood pressure and cholesterol management and healthy lifestyle counseling.
Less than 2 weeks after FDA approved the new indication (semaglutide is also approved for chronic weight management and type 2 diabetes), CMS issued a memorandum stating that Medicare Part D plans may cover AOMs if they are FDA approved for an additional medically accepted indication beyond only weight management. CMS’ guidance is prospective and is not limited to semaglutide. The guidance applies to all AOMs that may be approved in the future to treat other conditions.”
*snip*
Notably, FDA’s approval of semaglutide for cardiovascular disease is likely a harbinger of similar approvals in the near future — along with their coverage by Medicare. While the benefits are substantial, so too may be the costs as more and more drugs and patients receive coverage.”
The cost of drugs and vaccines are significant. The reason we’re willing to pay for them is that the costs of the alternatives are greater.
Count me as one who is glad for the success of semaglutides and that Medicare is acknowledging the net benefits of these drugs. Like antibiotics, statins and anti-hypertensives, semaglutides are transformative pharmacy.
Medicare Part D plans may cover anti-obesity meds
The high cost of prescription drugs is not a justification to reduce availability or funding.
It is a justification to reform funding models for drug development and reform patent laws so the industry is not permitted to extort whatever price it demands from patients, insurers, and governments.
There is no natural right for any intellectual property industry–including the pharmaceutical industry–to enjoy near permanent monopoly rents for goods that have a marginal production cost approaching zero.
The legal right for intellectual property industries to earn unlimited, essentially indefinite, economic rents was invented out of whole cloth purely to benefit the already wealthy at the expense of the public. It is an entirely fictitious right that can, and should, be revoked.
Yep. Semaglutides are cheap to manufacture. Their actual cost to patients reflects pharma pricing/profits. Putting them on the Medicare schedule could drive down prices. But if you expect Congress to revoke pharma intellectual property rents, that will happen co-terminus with the first verified report of porcine aviation.
So these AOMs can be included in Part D if there is a non-obesity approved use, which there now is for at least Wegovy. Does that mean the patient has to use it for the non-obesity diagnosis, or is that still not determined?
@Eric,
Like any prescription, the patient fills it or not and uses it or not. The doc writes the prescription for the indication. Prescriptions don’t come with a mechanism that makes sure you took it.
Joel:
That is true. If I do not take 50mg of Metoprolol, I also notice a difference during the day. First thing I do is look at my pill container for that day. I start to tire. It does have a black box warning. “Do not immediately stop taking it.” Fear of heart issues.
You are right on the take it or not take it. I would go back and talk with the doctor about it. Some are too rigid with you are the patient and I am the educated doctor routine. I was spoiled with my last Cardiologist. We could have a conversation about things which reinforced my belief in him.
Best to listen and ask questions. No answers, try another doctor.
I always thought curing obesity would be a big “welcome to the future” moment. It’s been wild seeing all the overweight famous people suddenly no longer being overweight. With the wide range of things they’re being prescribed for we’re probably not far off from seeing the same thing for the general population.
@QL,
Not just famous people. One of my sisters lost 100 lbs on Wegovy after struggling with overweight and obesity for a couple of decades.
The significance, as I allude to in my post, isn’t just cosmetic. Obesity is a risk factor for a bunch of diseases that are difficult and expensive to treat. Like many drugs, semaglutides are way cheaper than the alternatives.