Medicare Half D spending on 10 diabetes medicine reached $35.8 billion in 2023, a 364% enhance from 2019 at $7.7 billion, in line with a February report from the Workplace of Inspector Normal (OIG).
On the similar time, Medicare Half D enrollment has elevated 12% to 50.5 million enrollees in 2023 from 44.9 million in 2019, the report confirmed.
For the report, the OIG chosen 10 widespread kind 2 diabetes medicine and analyzed developments in spending for these medicine, in addition to developments within the variety of enrollees prescribed these medicine. The medicine chosen for the report embrace Mounjaro, Rybelsus, Ozempic, Trulicity, Bydureon, Victoza, Byetta, Invokana, Jardiance and Farxiga. At the moment, Medicare Half D covers diabetes medicine for kind 2 diabetes and heart problems however doesn’t cowl them for weight reduction.
“Sure diabetes medicine initially accepted by the Meals and Drug Administration (FDA) to assist management blood sugar ranges for people with kind 2 diabetes are recognized to be efficient weight reduction brokers,” the OIG acknowledged. “Prescriptions for and spending on diabetes medicine elevated considerably within the final 5 years.”
The OIG additionally discovered that Medicare Half D spending for GLP-1 Ozempic elevated by 1,567% to $9.2 billion in 2023 from $552 million in 2019. The variety of Half D enrollees filling a prescription for Ozempic rose 929% to just about 1.5 million in 2023, in comparison with over 142,000 in 2019.
By 2026, Medicare Half D spending on these 10 medicine is projected to achieve $102 billion, the OIG famous.
“This substantial enhance might have a monetary influence on the Medicare program. Info on this information temporary could also be useful to CMS and different policymakers when growing future program steerage associated to those medicine,” the OIG acknowledged within the report.
The report comes after the Biden administration launched a proposed rule in November that might cowl GLP-1s for weight problems below Medicare and Medicaid. Nevertheless, it’s unclear how the Trump administration will transfer ahead with the proposed rule. In January, greater than 70 organizations known as on the Trump administration to finalize the rule. This consists of the American Diabetes Affiliation, the Weight problems Motion Coalition and the Society for Girls’s Well being Analysis.
The OIG stated within the report that it “plans to conduct further audits associated to Medicare Half D utilization of and spending for choose diabetes medicine to find out whether or not diabetes medicine have been paid for in accordance with Federal necessities.”
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