Hostname: page-component-7479d7b7d-c9gpj Total loading time: 0 Render date: 2024-07-10T06:28:39.371Z Has data issue: false hasContentIssue false

Medicare Should Cover Weight Loss Drugs as Long as the Prices are Affordable

Published online by Cambridge University Press:  31 May 2024

Catherine S. Hwang
Affiliation:
DIVISION OF PHARMACOEPIDEMIOLOGY AND PHARMACOECONOMICS, DEPARTMENT OF MEDICINE, BRIGHAM AND WOMEN’S HOSPITAL AND HARVARD MEDICAL SCHOOL, BOSTON, MA
Aaron S. Kesselheim
Affiliation:
DIVISION OF PHARMACOEPIDEMIOLOGY AND PHARMACOECONOMICS, DEPARTMENT OF MEDICINE, BRIGHAM AND WOMEN’S HOSPITAL AND HARVARD MEDICAL SCHOOL, BOSTON, MA
Benjamin N. Rome
Affiliation:
DIVISION OF PHARMACOEPIDEMIOLOGY AND PHARMACOECONOMICS, DEPARTMENT OF MEDICINE, BRIGHAM AND WOMEN’S HOSPITAL AND HARVARD MEDICAL SCHOOL, BOSTON, MA

Abstract

Glucagon-like peptide-1 receptor agonists are effective for treating obesity, but the high cost of these medications endangers the financial viability of our health care system. To ensure that these drugs are available to Medicare beneficiaries, pharmaceutical manufacturers must lower their prices.

Type
Columns: Health Policy Portal
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of American Society of Law, Medicine & Ethics

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

About This Column

Aaron Kesselheim serves as the editor for Health Policy Portal. Dr. Kesselheim is the JLME editor-in-chief and director of the Program On Regulation, Therapeutics, And Law at Brigham and Women’s Hospital/Harvard Medical School. This column features timely analyses and perspectives on issues at the intersection of medicine, law, and health policy that are directly relevant to patient care. If you would like to submit to this section of JLME, please contact Dr. Kesselheim at akesselheim@bwh.harvard.edu.

References

Lincoff, A. M., et al., SELECT Trial Investigators, “Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes,” N Engl J Med 389, no. 24 (2023): 22212232, doi: 10.1056/NEJMoa2307563, Epub 2023 Nov 11, PMID: 37952131.Google Scholar
Jastreboff, A. M. et al., SURMOUNT-1 Investigators, “Tirzepatide Once Weekly for the Treatment of Obesity,” N Engl J Med 387, no, 3 (2022): 205216, doi: 10.1056/NEJMoa2206038, Epub 2022 Jun 4, PMID: 35658024.Google ScholarPubMed
US Food and Drug Administration. FDA Approves First Treatment to Reduce Risk of Serious Heart Problems Specifically in Adults with Obesity or Overweight, updated March 8, 2024, accessed March 28, 2024, available at < https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-reduce-risk-serious-heart-problems-specifically-adults-obesity-or> (last visited March 28, 2024).+(last+visited+March+28,+2024).>Google Scholar
Baig, K. et al., “Medicare Part D Coverage of Antiobesity Medications — Challenges and Uncertainty Ahead,” N Engl J Med 388, no. 11 (2023): 961963, doi: 10.1056/NEJMp2300516, Epub 2023 Mar 11, PMID: 36912541.Google ScholarPubMed
Sheahan, K. H., Wahlberg, E. A., and Gilbert, M. P., “An Overview of GLP-1 Agonists and Recent Cardiovascular Outcomes Trials,” Postgraduate Medical Journal 1133 (2020): 156161, doi: 10.1136/postgradmedj-2019-137186, Epub 2019 Dec 4, PMID: 31801807, PMCID: PMC7042958.Google Scholar
US Centers for Medicare and Medicaid Services, Reexamination of the 2022 Medicare Part B Premium, updated May 19, 2022, accessed March 13, 2024, available at <http://www.cms.gov/files/document/cms-report-secretary-2022-medicare-part-b-premium-reexamination.pdf> (last visited March 15, 2024).+(last+visited+March+15,+2024).>Google Scholar
US Centers for Medicare and Medicaid Services, 2023 Medicare Parts A & B Premiums and Deductibles 2023 Medicare Part D Income-Related Monthly Adjustment Amounts, updated September 27, 2022, accessed March 13, 2024, available at <https://www.cms.gov/newsroom/fact-sheets/2023-medicare-parts-b-premiums-and-deductibles-2023-medicare-part-d-income-related-monthly> (last visited March 15, 2024).+(last+visited+March+15,+2024).>Google Scholar
US Department of Health and Human Services, HHS Selects the First Drugs for Medicare Drug Price Negotiation, updated August 29, 2023, accessed March 13, 2024, available at <https://www.hhs.gov/about/news/2023/08/29/hhs-selects-the-first-drugs-for-medicare-drug-price-negotiation.html> (last visited March 15, 2024).+(last+visited+March+15,+2024).>Google Scholar
Sarnak, D. O., Squires, D., and Bishop, S., “Paying for Prescription Drugs Around the World: Why Is the U.S. an Outlier?” updated October 5, 2017, accessed March 13, 2024, available at <https://www.commonwealthfund.org/publications/issue-briefs/2017/oct/paying-prescription-drugs-around-world-why-us-outlier> (last visited March 15, 2024).+(last+visited+March+15,+2024).>Google Scholar
Kapczynski, A., Kesselheim, A. S., “Government Patent Use: A Legal Approach To Reducing Drug Spending,” Health Affairs (Millwood) 35, no, 5 (2016) 791797, doi: 10.1377/hlthaff.2015.1120. PMID: 27140984.Google ScholarPubMed
Vedantam, S., Chea, T., Drug Firm Plays Defense in Anthrax Scare,” Washington Post, Updated October 20, 2001, accessed March 28, 2024, available at <https://www.washingtonpost.com/archive/politics/2001/10/21/drug-firm-plays-defense-in-anthrax-scare/21e1bf4c-0070-4b00-bdb6-459a9642f219/ > (last visited March 28, 2024).+(last+visited+March+28,+2024).>Google Scholar
Novo Nordisk, Financial Report for the Period 1 January 2023 to 31 December 2023, updated January 31, 2024, accessed March 13, 2024, available at <https://ml-eu.globenewswire.com/Resource/Download/b4ae7c0b-df06-49cd-a1b9-50d5d566e6bc> (last visited March 15, 2024).+(last+visited+March+15,+2024).>Google Scholar
Lilly, Eli, “Lilly Reports Strong Fourth-Quarter 2023 Financial Results and Provides 2024 Guidance,” updated February 6, 2024, accessed March 13, 2024, available at <https://investor.lilly.com/static-files/fd0ef78b-4c48-4a15-b65b-8bf9b6ed26d2> (last visited March 15, 2024).+(last+visited+March+15,+2024).>Google Scholar
Barber, M. J., Gotham, D., Bygrave, H., Cepuch, C., “Estimated Sustainable Cost-Based Prices for Diabetes Medicines,” JAMA Netw Open 7, no, 3 (2024): e243474. doi: 10.1001/jamanetworkopen.2024.3474. PMID: 38536176.Google ScholarPubMed
Congressional Budget Office, “Estimated Budgetary Effects of Public Law 117-169, to Provide for Reconciliation Pursuant to Title II of S. Con. Res. 14,” updated September 7, 2022, accessed March 13, 2024, available at <https://www.cbo.gov/publication/58455> (last visited March 15, 2024).+(last+visited+March+15,+2024).>Google Scholar