全球制药业洞察 | 减肥药物将纳入美国医保？

Core Viewpoint - The article discusses the increasing likelihood of Medicare covering weight loss medications, driven by political support and potential health benefits, with projected new drug spending reaching $35 billion over the next nine years depending on legislative adjustments [3][4][10]. Group 1: Medicare Coverage Expansion - The Biden administration is considering a pilot project to include Novo Nordisk and Eli Lilly's weight loss drugs under Medicare coverage, influenced by the health benefits these medications provide [3]. - A bipartisan-supported bill passed in 2024 allows Medicare to cover weight loss drugs for new beneficiaries who have used them for at least a year prior to enrollment [4]. - Approximately 34% of Medicare beneficiaries are estimated to be obese, highlighting a significant market opportunity for weight loss medications [4]. Group 2: Medicaid and Cost Concerns - The proposed changes may significantly impact Medicaid, where the obesity rate is around 40%, potentially addressing slow coverage expansion due to cost concerns [7]. - Currently, only 13 states cover weight loss medications under Medicaid, with California recently reducing its coverage due to budget constraints [7]. - Since 2019, spending on weight loss medications, including those for diabetes, has grown at a compound annual growth rate of 61%, indicating increasing adoption and new therapies entering the market [7]. Group 3: Drug Pricing and Legislative Context - The timing of the potential Medicare pilot project aligns with the implementation of the Inflation Reduction Act (IRA) drug pricing negotiations, suggesting imminent price reductions for weight loss drugs [10]. - The Congressional Budget Office (CBO) estimates that covering weight loss medications could lead to $35 billion in spending over the next nine years, with Medicare seeking to negotiate prices below current net prices [10][12]. - Previous legislative attempts to expand coverage for weight loss medications failed due to cost concerns, but recent FDA approvals for new drugs may change this dynamic [12].