Maia Lura Anderson’s Post

This is an interesting survey by KFF, with some food for thought and forward-looking considerations, as stated in the last sentence of this article, on how this increasing demand WILL INDEED put a strain on the already challenged federal Medicare program. 🗓 Survey conducted between 23 April and 1 May 🧑 n= 1479 US adults 1️⃣ in 8️⃣ have taken an anti-obesity med; for those with diabetes, it is 4️⃣ in 10 ✅ 61% say Medicare should cover GLP-1 agonists to treat obesity, even if it means an increase in premiums Though the majority are using these drugs for diabetes and other CVM benefits, there is still a fair percentage (38% in this study) utilizing them 'just for weight loss'. #GLP1 #antiobesity #Pharma #Healthcare

The Wall Street Journal’s Peter Loftus writes ‘…Medicare Opens Door for Covering Obesity Drugs.’ This is only ‘…as long as they have a history of heart disease and are using it to prevent recurring heart attacks and strokes.’ The approach is based upon recent FDA approval for use of anti-obesity medications such as Wegovy, to reduce the risk of heart attacks and strokes in people with a history of cardiovascular disease, and who have a body-mass index above a certain threshold. Last year, Novo Nordisk published high level outcomes of a study with Wegovy to decrease cardiovascular risk by about 20% versus a placebo, or dummy drug. About 10 million Medicare beneficiaries are said to be obese; paying for just a tenth of these members at the current list price of $1,300 per month, would cost about $26 billion, or almost one-fifth of the total Medicare budget. Beyond cost, how will Novo Nordisk ensure supplies for the newly eligible individuals? Loftus additionally notes ‘…CMS said anti-obesity medications still aren’t eligible for Part D coverage if they are used for weight loss alone.’ This is a move in the right direction; obesity is a chronic disease, and its treatment can impact people with co-existing cardiovascular diseases such as high blood pressure, and stroke, as well as sleep apnea, polycystic ovarian disease, hip and knee osteoarthritis, and liver disease. We can treat this disease burden, to enable people to live healthier and happier lives, and reduce total costs of care. https://lnkd.in/eiAGWVVi

🔍 **Insight into Semaglutide's Impact on U.S. Health Costs and Access** A recent analysis reveals that over 136 million American adults could potentially benefit from semaglutide, the GLP-1 drug marketed as Ozempic for diabetes and Wegovy for weight management. Beyond these uses, semaglutide may also aid in preventing heart disease. Despite the promising health benefits, the costs—approximately $1,000 per month—pose significant financial barriers. Currently, insurance coverage predominantly supports its use for type 2 diabetes. With 2023 net sales reaching $13.8 billion, semaglutide's pricing remains under scrutiny. While pharmaceutical firms emphasize the role of pharmacy benefit managers (PBMs) in cost decisions, economic accessibility remains a critical issue, with less than half of eligible patients receiving coverage through Medicare or Medicaid. As healthcare professionals and policymakers navigate these challenges, prioritizing affordability and broadening coverage could enhance health outcomes and access for millions. #Healthcare #Pharmaceuticals #Semaglutide #AccessToCare #InnovationInMedicine

The fact that covering GLP-1s under Medicare Part D for authorized uses is already making a mark on total Part D program spending could be a sign of even higher spending to come as Part D plans are now able to cover Wegovy for its heart health benefits, if other uses for GLP-1s are approved, and as policymakers consider legislation that would authorize Medicare to cover obesity drugs. https://ow.ly/xuZC50R2t3o

🚨 Exciting News for Medicare Beneficiaries: Major Medication Price Reductions! 🚨 We have some fantastic news that could make a big difference in your healthcare costs! Thanks to newly negotiated prices, the cost of several essential medications has been significantly reduced. 🌟 Here are some of the medications now available at a lower cost: Eliquis (Blood Thinner) Xarelto (Blood Thinner) Januvia (Diabetes) Jardiance (Diabetes) Enbrel (Arthritis) Imbruvica (Cancer) Farxiga (Heart Failure/Diabetes) Entresto (Heart Failure) Stelara (Psoriasis/Crohn’s) Fiasp and NovoLog (Insulin for Diabetes) These reduced prices offer significant savings compared to the 2023 list prices of these vital medications. For more details and to see how these changes can benefit you, check out the full article here: https://nbcnews.to/46Lc0MI Stay informed and take advantage of these savings! 💊💰 #lowercosts #LIFEseniorservices #medicare

In 2025, the prescription drug landscape will face a perfect storm: First, government regulations will implement a $2000 cap on prescription drug plans. Second, with this government-mandated cap, insurers face with increased costs, leading to inevitable adjustments in premiums to cover the shortfall.  Third, ongoing government mandates to cover drugs such as Wegovy (a weight loss medication) aim to address public health concerns, but raise questions about who ultimately bears the cost burden. AND this question of who pays only becomes more contentious.  #Medicare #Medicaid

"While it's clear that semaglutide and tirzepatide represent tremendous advances in obesity management, what does it matter if no one can afford them?" I recently spoke with Business Insider about the significant price barriers surrounding weight-loss drugs and the impact of insurers dropping coverage. As an obesity medicine physician, I see firsthand the challenges patients face in accessing life-changing medications like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound). Countless patients have tried nearly every strategy to obtain these medications—cycling on and off the drugs, rationing doses, or turning to unregulated alternatives due to financial constraints. This compromises their health and exposes them to unnecessary risks. While we await changes in pricing or insurance coverage, the situation remains frustrating for both patients and healthcare providers. Read more about the challenges and risks patients are facing here:  https://lnkd.in/g3cxsAPr #ObesityMedicine #GLP1 #WeightLossDrugs 

The latest news regarding Wegovy and Medicare is that for the first time, Medicare will cover the weight-loss drug Wegovy for enrollees in Part D plans, but only when it’s prescribed to prevent heart attacks and strokes. This policy change follows a new FDA approval that allows Wegovy to be used for reducing the risk of heart disease in patients who are overweight or have obesity. This is a significant development because Medicare Part D has historically not covered obesity drugs.under the new guidance, such drugs will be paid for if they receive FDA approval for an additional medically accepted indication, like reducing the risk of cardiovascular events. It’s important to note that Medicare will not cover Wegovy if it’s solely being used for weight management without the cardiovascular risk reduction indication. This decision could potentially provide access to millions of Americans who are at an increased risk of heart-related health issues due to their weight. https://lnkd.in/gP_h_XYZ

FDA-approved approved #Leqembi is the latest medication for #Alzheimers treatment. This pricey drug is covered by #Medicare—but the cost sharing amount for beneficiaries can be high. As #MedicareOpenEnrollment continues, learn how Leqembi works, who can get it, and what people with Medicare can expect to pay out of pocket.👇 #AlzheimersAwarenessMonth https://lnkd.in/eF2TH8ue

Prescription Drug Coverage for Treatment of Low Back Pain Among US Medicaid, Medicare Advantage, and Commercial Insurers Understanding medication coverage policies is crucial in the context of the ongoing opioid crisis. Study assesses how different US insurers cover medications for chronic noncancer pain, specifically low back pain. This research provides insights into the disparities and common practices among Medicaid, Medicare Advantage, and commercial health plans. Key Findings: ➡️ Medicaid plans cover a median of 19 opioids and 22 nonopioid analgesics. ➡️ Medicare Advantage plans show similar coverage patterns. ➡️ Commercial plans cover more opioids and nonopioids compared to Medicaid and Medicare Advantage. ➡️ Utilization management strategies, such as 30-day quantity limits, are commonly applied to opioids across all plan types. ➡️ Nonopioids also face utilization management, including quantity limits and prior authorization. ➡️ Emphasis on increasing opioid utilization management was highlighted, with a focus on high-risk prescribers and patients. This study emphasizes the need to optimize formulary placement, utilization management, copayments, and integration of nonpharmacologic treatments to enhance pain care and reduce opioid-related injuries and deaths. 📚 Authors: Dora Lin, Christopher M Jones, Wilson M Compton, James Heyward, Jan L Losby, Irene Berita Murimi-Worstell, Grant Baldwin, Jeromie Ballreich, David A Thomas, Mark Bicket, MD, PhD, FASA, Linda Porter, Jonothan Tierce, G. Caleb Alexander 🔗 https://lnkd.in/daUkKj77 #OpioidCrisis #PainManagement #HealthPolicy #MedicalResearch #PhysicianInsights #CME #HealthcareCoverage