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Covering weight loss drugs for older Americans in state-sponsored Medicare health insurance programs will cost the U.S. government $35 billion over the next nine years, a Congressional analysis has found.
Medicare, which currently provides prescription drugs to about 54 million people age 65 and older in the U.S., offers Novo Nord, which is targeted at patients who suffer from other comorbidities, such as stroke risk, heart disease, or sleep apnea. It only covers anti-obesity drugs such as Disc’s blockbuster product Wigoby.
Anti-obesity drug giants Novo Nordisk and Eli Lilly are asking lawmakers to change the rules to allow their drugs to target obesity only. The law prohibits Medicare from covering anti-obesity drugs solely for weight loss, but a bill being considered in the House aims to change that.
Expanding drug coverage starting in early 2026 would cost the federal government about $1.6 billion to cover costs for an estimated 300,000 patients in the first year, according to a Congressional Budget Office analysis released Tuesday. It was determined that the total amount would eventually increase to $7.1 billion. Covering 1.6 million patients by 2034 is projected to cost $35 billion over nine years.
The analysis concluded that cost savings from other health improvements touted by drug companies promoting expanded drug coverage do not offset the cost of treatment. In 2034, such savings would amount to about $1 billion, CBO found.
Net Medicare spending on prescription drugs this year is expected to total about $120 billion.
This long-awaited analysis comes as debate over the cost of treatment grows and health systems begin to plan for a future in which treatments are increasingly available. Democratic Sen. Bernie Sanders accused Novo Nordisk of “swindling” Americans with wholesale prices of nearly $1,350 a month on Wegobee and warned that these drugs could bankrupt Medicare. .
Novo Nordisk and Zepbound maker Eli Lilly are working on trials of the drug in other indications, including sleep apnea, and regulatory data could pave the way for a Medicare-covered treatment. Submitted to the authorities.
“We’re going to eat the elephant here one step at a time… not just by losing weight, but by proving signs of that outcome,” Eli Lilly CEO Dave Rix told the Financial Times last month. spoke. He predicted that insurance companies and Medicare would eventually come to the logic of covering drugs solely for weight loss.
Benedick Ippolito, a senior fellow at the think tank American Enterprise Institute, said while $35 billion is “an inconsequential amount,” it’s a “borderline doomsday scenario” that suggests drugs could bankrupt Medicare. “It’s not catastrophic,” he said.
