"The big picture: The manufacturers have agreed to cut the price Medicare pays for GLP-1s it already covers for diabetes and other indications to $245 per dose. That's about one-ninth of the current list price for the drugs, according to a senior administration official. Medicare spent $5.7 billion on GLP-1s to treat diabetes in 2022, per KFF. The savings generated from that lower price will be used to expand Medicare coverage of GLP-1s for more indications starting in mid-2026."
"Zoom in: Coverage will be newly available to seniors who are severely obese with a body mass index of greater than 35, along with those who are overweight and have prediabetes or cardiovascular disease, and those who are obese and have advance kidney disease, heart failure or uncontrolled hypertension. Medicare enrollees will pay only a $50 copay out of pocket for GLP-1s, officials said."
"The announcement could make it easier for seniors to use popular drugs like Novo Nordisk's Ozempic and Wegovy and Eli Lilly's Zepbound. It also lowers the price of the drugs for state Medicaid programs, which could increase coverage for lower-income Americans. The expanded Medicare coverage will be available through a pilot program, according to a statement from Novo Nordisk."
Manufacturers agreed to reduce the Medicare price for covered GLP-1 drugs to $245 per dose, roughly one-ninth of current list prices. Medicare spent $5.7 billion on GLP-1s for diabetes in 2022. Savings from the lower price will fund expanded Medicare coverage for additional indications beginning mid-2026 via a pilot program. New eligibility includes seniors with BMI over 35, overweight beneficiaries with prediabetes or cardiovascular disease, and obese beneficiaries with advanced kidney disease, heart failure, or uncontrolled hypertension. Medicare enrollees will face a $50 copay. The $245 price will also be offered to state Medicaid programs, with optional state participation, and a cash-pay option will appear on TrumpRx priced at $350 or less trending to $245 over two years.
Read at Axios
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