'5 things to know about GLP-1 use in Medicare: KFF'

 Participating Medicare Part D plans can officially begin covering weight-loss treatment in 2027. 

The initiative falls under CMS’ voluntary “Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth” — or BALANCE — model. The December news followed President Donald Trump’s negotiations with Eli Lilly and Novo Nordisk to secure most-favored-nation pricing for drugs that treat obesity, diabetes and related conditions.

To better understand Medicare usage and spending shifts, KFF analyzed CMS data from 2019 through 2024. 

Here are five takeaways:

1. Two million Part D enrollees used Ozempic in 2024, versus fewer than 150,000 in 2019.

2. Mounjaro reached nearly 1 million Part D enrollees in 2024, up from 54,000, after it was approved as a treatment for Type 2 diabetes in 2022.

3. During the evaluated time period, there was a fivefold increase in Medicare Part D gross spending on GLP-1s.

4. Despite that jump, assumed rebates based on MedPAC estimates hover around 50%, indicating lower net spending than expected.

5. GLP-1 claims between 2019 and 2024 increased fourfold.

https://www.beckershospitalreview.com/glp-1s/5-things-to-know-about-glp-1-use-in-medicare-kff/