Elaine Chen at STAT on new studies to suggest GLP-1 health care costs have only begun to climb.
Large employers are trying to limit the costs of the expensive new generation of weight-loss drugs, from POLITICO.
Delayed gastric emptying and pulmonary aspiration following induction of anesthesia in patients using GLP-1 drugs is not an issue, as per JAMA.
The Kaiser Family Foundation analyzed Medicare data from 2020; an estimated 7% of Medicare beneficiaries, or 3.6 million overall were candidates for for GLP-1 drug Wegovy.
NEWS
Elaine Chen at STAT on new studies to suggest GLP-1 health care costs have only begun to climb.
The American Society of Health-System Pharmacists found that GLP-1 treatments were a main driver of the increase in overall drug spending by health entities such as pharmacies and hospitals last year.
The health policy research organization KFF, notes Medicare could spend $2.8 billion in a year on Wegovy.
Stacie Dusetzina, a health policy professor at Vanderbilt University Medical Center said ‘…We see that the use has already skyrocketed despite these massive amounts of constraints holding it back…’ and ‘…would expect use to go way up.’
Appropriately, Tricia Neuman, senior vice president of KFF, said that while the drug could increase costs in the short term, they could, as pharma companies argue, be worth it for Medicare by preventing cardiovascular problems and eventually saving costs in the long run.
OPINION
Large employers are trying to limit the costs of the expensive new generation of weight-loss drugs, from POLITICO.
Rebates amounting an up to 40% discount off the list price of GLP-1 meds are only available to the employers if it ‘…agreed to allow all patients with a prescription to get the drugs without any preliminary hurdles.’
The state of North Carolina, with 750,000 public employees wanted to save money by limiting prescriptions to patients who first tried lifestyle management programs to lose weight.
The manufacturer, Novo Nordisk, and the state’s pharmacy benefit manager, CVS Caremark, refused to provide the rebates, and so the state plan’s board voted to stop covering the drugs.
Sam Watts, the administrator of the North Carolina State Health Plan said ‘…I’ve got to take it or leave it. I have to pay for everybody, even the folks for whom it is not cost effective in order to get it for the folks it would be cost-effective for.’
CVS Caremark, which manages prescription benefits for North Carolina’s plan, pointed the finger at the manufacturer.
CVS said it can’t pass on rebates from drugmakers if the state doesn’t meet certain terms of its contract with the manufacturer.
Across the country, large employers face ‘…similar resistance from pharmacy benefit managers and drugmakers when implementing lifestyle management programs to cut down on the costs of weight-loss drugs.’
Novo Nordisk says this is irresponsible.
Nicole Ferreira, a spokesperson at Novo said the company ‘…strongly opposes creating new hurdles for patient access to care.’
Matthew Fiedler, a senior fellow at Brookings’ Center on Health Policy makes it clear that if employers are going to restrict the volume of drugs sold, they’re not going to get a discount from the manufacturer on the drugs in most cases.
Ultimately, with high drugs prices, and the U.S. drug industry approach to pricing and rebates, it is going to be an all-or-nothing approach, until prices come down.
James Gelfand, president and CEO of the ERISA Industry Committee, which represents the benefits interests of large employers, rightly states ‘…employers are not going to cover these drugs… Because the loss of all the rebates makes the price too crazy.’
DATA
Delayed gastric emptying and pulmonary aspiration following induction of anesthesia in patients using GLP-1 drugs was evaluated across over 23,000 patients by Dixit et al. in JAMA.
Just about three and half thousand were on GLP-1 medications, and there was no significant difference in the incidence of postoperative respiratory complications between those on a GLP-1 drug versus those not on the drug.
The authors suggest ‘…liberalizing the withholding guidelines for GLP-1 RAs preoperatively should be considered.’
Whilst a small study, I do think that anyone on a GLP-1 medication should inform their clinician, especially if they are to undergo a procedure under sedation or general anesthesia.
The Kaiser Family Foundation reviews Medicare coverage for GLP-1 drug Wegovy to reduce the risk of heart attacks and stroke in people with cardiovascular disease who are overweight or obese.
Based on KFF analysis of Medicare data from 2020, an estimated 7% of Medicare beneficiaries, or 3.6 million overall, had established cardiovascular disease and obesity or overweight and are thus eligible for the new indication, with a total of 13.7 million Medicare beneficiaries diagnosed as being overweight or obese in 2020.
The article notes some Part D plans have already announced that they will begin covering Wegovy this year.
With a 50% rebate on the list price of $1,300 per month (or $15,600 per year), and 10% of the target population (an estimated 360,000 people) on Wegovy for a full year, the additional net Medicare Part D spend would be $2.8 billion for one year.
ADDITIONAL TOPICS
Reuters reports Eli Lilly to acquire manufacturing facility from Nexus Pharma.
Modern Healthcare on Medicare Advantage insurers mull Wegovy coverage ‘trade-offs’.
The New York Times on Senate Committee Investigates Ozempic and Wegovy Costs.
