Study estimates 1 in 7 Medicare beneficiaries with high BMI may qualify for anti-obesity drug

A brand new examine led by investigators from Brigham and Women’s Hospital, a founding member of the Mass General Brigham well being care system, estimates that 3.6 million Medicare beneficiaries are most certainly to grow to be eligible for semaglutide.

If Medicare Part D narrowly defines heart problems, nearly all of sufferers would stay ineligible, whereas new federal spending may nonetheless exceed $10 billion.

Current federal regulation restricts Medicare from masking medicine prescribed solely for weight reduction. However, in March 2024, Medicare introduced it might prolong protection to semaglutide (Wegovy), a well-liked glucagon-like peptide-1 receptor agonist (GLP-1RA), for sufferers with elevated physique mass index (BMI) who additionally had established heart problems (CVD).

This implies that the definition of “established CVD,” which has not been formally codified, can have outsized impacts on each public well being and Medicare prices.

The examine additionally estimates eligibility and related most prices if totally different definitions of cardiovascular threat had been to be thought-about. The findings are revealed within the Annals of Internal Medicine.

The analysis crew analyzed information from respondents over 65 or who had been on Medicare and who took half within the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2020. They discovered that if all sufferers with elevated BMI and a historical past of coronary heart assault, stroke, coronary artery illness, or angina had been handled with semaglutide, most annual prices to Medicare may very well be as excessive as $34.3 billion after rebates.

“When established heart problems is narrowly outlined, just one in 7 Medicare beneficiaries with elevated BMI are prone to be eligible to obtain semaglutide, however prices to Medicare may nonetheless exceed $10 billion per 12 months,” mentioned lead writer Alexander Chaitoff, MD, MPH, of the Center for Health care Delivery Sciences within the Division of Pharmacoepidemiology at BWH.

“In this conservative protection state of affairs, which means most beneficiaries with elevated BMI and cardiovascular threat would stay ineligible for semaglutide, but the remedy may nonetheless doubtlessly grow to be one of many costliest medicine for Medicare.”