Benedic Ippolito (
Joseph F. Levy, Johns Hopkins University, Baltimore, Maryland.
Health Aff (Millwood). 2024 Sep;43(9):1254-1262. doi: 10.1377/hlthaff.2024.00356. Epub 2024 Aug 15.
The introduction of highly effective anti-obesity drugs, such as Wegovy, has prompted debate over Medicare's prohibition on coverage of such products. In this study, we estimated the costs of allowing Medicare coverage of anti-obesity medications. Our analysis incorporated data on drug costs, real-world adherence rates, and potential changes to other health care spending. Using Medicare claims, we also documented beneficiaries' eligibility for nearly identical products approved for different indications. Assuming that anti-obesity drugs were covered in 2025 and that 5 percent or 10 percent of newly eligible patients were prescribed one, annual Part D costs were estimated to increase by $3.1 billion or $6.1 billion, respectively. The marginal costs of this policy could fall by as much as 62.5 percent from baseline estimates if products were approved for additional indications in coming years because these additional conditions are common among people with obesity. This would increase Medicare spending but would occur regardless of a policy change. Longer-term estimates come with significant uncertainty about utilization and price changes, but these results are consistent with this policy change likely increasing Medicare costs by the low to middle tens of billions of dollars over ten years.
高效减肥药（如 Wegovy）的问世引发了关于医疗保险是否应覆盖此类产品的争论。本研究旨在评估允许医疗保险覆盖减肥药的成本。我们的分析纳入了药品成本、实际用药依从率以及对其他医疗保健支出潜在变化的相关数据。我们还利用医疗保险索赔数据，记录了受益人为不同适应症获批的几乎相同产品的参保资格。假设 2025 年开始覆盖减肥药，如果有 5%或 10%的新符合条件的患者开了处方，那么每年的 Part D 成本预计将分别增加 31 亿美元或 61 亿美元。如果未来几年获批用于其他适应症，该政策的边际成本可能会比基线估计减少多达 62.5%，因为这些额外的病症在肥胖人群中很常见。这将增加医疗保险支出，但无论政策是否发生变化，这种情况都会出现。关于使用情况和价格变化的长期预测存在很大的不确定性，但这些结果表明，这一政策变化可能会使医疗保险在十年内增加数十亿美元的支出。
