Medicare Coverage Gap Linked to Reduced Prescription Rates for GLP-1 Weight Loss Drugs

1. A recent study by Truveta has found that the lack of Medicare coverage for GLP-1 weight loss drugs, such as semaglutide (Wegovy), tirzepatide (Mounjaro), and liraglutide (Saxenda), may be contributing to lower prescription rates.
2. The U.S. Congress is considering legislation like the Treat and Reduce Obesity Act (TROA) to expand Medicare coverage for these medications, which are currently approved for treating obesity but not covered under Medicare.
3. Lawmakers argue that covering these treatments could lead to increased competition among drug manufacturers, resulting in reduced prices and improved accessibility for patients.
4. Despite being prohibited from covering GLP-1 drugs for weight loss, gross total spending on Ozempic, Rybelsus, and Mounjaro reached $5.7 billion in 2022 due to their use for diabetes management.
5. The potential for higher spending on Medicare Part D plans and premiums for Part D coverage is raised as new uses for GLP-1s are approved or if they become eligible for coverage under Medicare.
6. Clinical trials have shown that GLP-1 receptor agonists can help individuals with obesity lose significant amounts of body weight safely, potentially reducing the risk of other diseases associated with obesity, such as heart disease.