Weight-loss drugs are so popular they’re headed for Medicare negotiations

Ozempic is out of reach for some patients. Can Medicare help?

The steep prices — and popularity — of Ozempic and similar weight-loss and diabetes drugs could soon make them a priority for Medicare drug price negotiations. List prices for a month’s supply of the drugs range from $936 to $1,349, according to the Peterson-KFF Health System Tracker.

The Inflation Reduction Act President Biden signed in 2022 paved the way for the federal program to negotiate prices directly with drugmakers for the first time. But for now, the high price of Ozempic, Trulicity and other drugs in the class known as GLP-1 agonists have put them out of reach for many low-income patients.

Novo Nordisk’s Ozempic and Wegovy could be eligible for negotiation as early as 2025, said Juliette Cubanski, deputy director of the Program on Medicare Policy at KFF. Lilly’s Trulicity may follow the next year.

Medicare shelled out $5.7 billion in 2022 for three popular GLP-1 drugs, up from $57 million in 2018, according to research by KFF. The “outrageously high” prices have “the potential to bankrupt Medicare, Medicaid, and our entire health care system,” Sen. Bernie Sanders (I-Vt.), who chairs the Senate Committee on Health, Education, Labor and Pensions, wrote in a letter to Novo Nordisk in April.

That spending will continue to skyrocket as the benefits of these drugs pile up. Medicare can’t cover the drugs for weight loss alone, but the program does cover them when prescribed to treat diabetes. Wegovy, a version of Ozempic, has also been approved to treat heart disease and the compound has shown promise in treating kidney disease.

The drugs are likely choices for Medicare haggling, according to the Congressional Budget Office.

But just how much will prices come down?

We’ll learn whether Medicare is a good bargainer in September, when the negotiated prices of the first 10 drugs selected for the process are published, Cubanski said.

While the negotiations will initially help only Medicare beneficiaries, other patients could see a benefit once prices are made public and drugmakers start feeling pressure. That’s what happened after the Inflation Reduction Act capped insulin prices for Medicare enrollees at $35 a month.

Another wild card? The winner of the November election. Biden’s been touting Medicare drug price negotiations on the campaign trail.

Trump talked a lot about driving down drug prices in his first term, but he eventually backed off letting Medicare negotiate. It’s unclear whether Trump would take on drugmakers — or his own party — during a second term.

Congressional Republicans voted against the IRA and some have put forward proposals to repeal it.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling and journalism.

Conservatives tied to Trump want to limit insurance coverage for abortions

Conservative policymakers influential with Donald Trump are discussing how to use a little-known labor law to impose sweeping restrictions on private-employer-covered abortions, The Washington Post’s Lauren Kaori Gurley and Jeff Stein report.

Although the former president hasn’t formally committed to anything and talks are ongoing, the Heritage Foundation, a conservative think tank, has recommended that the Labor Department and Congress clarify that federal labor regulations for employer-sponsored health-care plans “should not be allowed to trump states’ ability to protect innocent human life in the womb.”

A separate proposal being considered by Trump labor advisers would rescind a new federal rule that takes effect this month requiring most U.S. employers to offer “reasonable accommodations” for their workers related to pregnancy and childbirth, including time off for abortions.

Why it matters: Although data is hard to come by, thousands of women are accessing abortions by traveling out of state, and it’s likely they are using private-employer insurance to do so, said Liz McCaman Taylor, senior federal policy counsel at the Center for Reproductive Rights.

Yes, but: Several GOP policy advisers downplayed the likelihood a Trump Labor Department would take this step, pointing out that the campaign has appeared wary of embracing additional policies that could fuel the backlash to the fall of Roe v. Wade.

FDA reverses ban on Juul vape products

The Food and Drug Administration reversed its ban on e-cigarette products manufactured by Juul, the company widely recognized as a catalyst for the youth vaping craze, our colleague David Ovalle reports.

Consumers won’t see an immediate change, as Juul products have remained on shelves during the company’s appeal of the initial June 2022 decision. The FDA emphasized that the move isn’t an approval of Juul’s marketing applications, but instead reclassifies them to pending review status.

A closer look: The initial FDA ban stemmed from concerns over “insufficient and conflicting data” regarding potential DNA damage and harmful chemicals leaching from Juul’s e-cigarette devices and pre-filled cartridges.

The FDA said its decision to rescind the ban was made in light of court cases involving the vaping industry because the agency has since “gained more experience” with scientific issues involving e-cigarette products.

The view from Juul: The company said in a statement it remains confident that a “full review of the science and evidence” will show its products are safe for the public.

On our radar: The agency’s move involving one of the industry’s leading players comes as the Supreme Court is scheduled on June 20 to privately discuss for the first time whether to weigh in on conflicting lower-court decisions involving FDA regulation of e-cigarette products for other companies.

In other news from the agencies …

• New this a.m.: The Centers for Medicare and Medicaid Services will award $500 million in grants over the next five years to navigator programs across the country, which assist consumers in signing up for health coverage.
• The National Institutes of Health is launching a $30 million pilot program to test the feasibility of a national network that integrates clinical research with community-based primary care.
• FDA staff questioned whether Eli Lilly’s experimental Alzheimer’s drug, donanemab, should be approved for all patients with early-stage disease in briefing documents released ahead of an advisory committee meeting on Monday.

SCOTUS backs Native American tribes in health-care dispute

The Supreme Court ruled yesterday that Native American tribes can sue the federal government to recoup administrative expenses related to managing their own health-care programs.

Reimbursing these costs is “necessary to prevent a funding gap,” Chief Justice John G. Roberts Jr. wrote in the majority opinion, joined by the court’s three liberals and conservative Justice Neil M. Gorsuch. Roberts wrote that ruling against the tribes would essentially penalize them for pursuing self-determination.

Key context: Federal law permits tribes to assume control of their health-care programs through contracts with the Indian Health Service. The agency then reimburses them using funds equivalent to what it would have allocated if it operated the programs directly.

The Department of Health and Human Services had argued that it isn’t obligated to cover expenses associated with third-party insurers like Medicare, Medicaid and private payers. The government estimated that meeting these costs for all tribes operating their own programs could cost between $800 million and $2 billion annually.

In a statement after the ruling, HHS Secretary Xavier Becerra urged Congress to shift the IHS budget from discretionary to mandatory funding starting in fiscal 2026 to account for the potential budgetary impact of the decision.

“They said the same thing about Roe v. Wade — that no one’s coming after this protection that was established law for decades. And here we are.”

— Virginia state Sen. Ghazala Hashmi (D), on Republicans who claim they will not attempt to limit access to birth control.

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Staff at drugmaker under U.S. scrutiny worked with Chinese military scientists (By Kirsty Needham and Andrew Silver | Reuters)

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