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Cited by 43Pharmacology and Obesity TreatmentHealth Systems, Economic Evaluations, Quality of LifeHealthcare Policy and Management

The DOI matches its Crossref record; 30 of the 30 references it cites were found in a registry or an index.

Fiscal Impact of Expanded Medicare Coverage for GLP-1 Receptor Agonists to Treat Obesity

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Hwang, Jennifer H., Laiteerapong, Neda, Huang, Elbert S., Mozaffarian, Dariush, Fendrick, A. Mark, Kim, David D.·2025·JAMA Health Forum
DOI 10.1001/jamahealthforum.2025.0905PMC PMC12032556
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Abstract

Importance: Despite the clinical benefits of treating obesity and related complications, glucagon-like peptide-1 receptor agonists (GLP-1RAs) are not yet covered by Medicare Part D, partly due to high drug costs. The Biden administration's proposal to expand Part D coverage underscores the need to assess the balance between fiscal costs and benefits to guide policy decisions. Objective: To estimate the 10-year net fiscal impact of expanded Medicare coverage for GLP-1RAs for obesity treatment. Design, Setting, and Participants: In this economic evaluation, a 10-year fiscal impact analysis was conducted between 2026 and 2035 using the validated Diabetes, Obesity, Cardiovascular Disease Microsimulation model. The base-case analysis incorporated a 10% 1-time uptake rate for eligible adults in each new cohort, 40% adherence beyond the first year, and a 10% additional price discount beyond current net prices. A 3-way sensitivity analysis was conducted with varying uptake, adherence, and additional price discounts. The model included current and future Medicare beneficiaries with body mass index (calculated as weight in kilograms divided by height in meters squared) of 30 and higher or 27 and higher with at least 1 obesity-related comorbidity. Data were analyzed from March to December 2024. Exposure: GLP-1RA therapy. Main Outcomes and Measures: Total Medicare drug costs for GLP-1RAs for obesity indications not covered by Medicare, long-term health care cost offsets from reduced obesity-related comorbidities, and net fiscal impact. Results: Among 30 million cumulative Medicare beneficiaries (survey-weighted mean [SE] age, 64.5 [0.4] years; 54.1% female) identified as eligible for new GLP-1RAs for obesity treatment over the next 10 years, the base-case analysis estimated that 3 million would receive treatment. Medicare's total drug costs were projected at $65.9 billion and health care cost offsets from clinical benefits at $18.2 billion, resulting in net increased spending of $47.7 billion. Three-way sensitivity analysis estimated that higher uptake and adherence would lead to increased health care savings from clinical benefits. However, these savings were estimated to remain less than additional spending on GLP-1RAs and to extensively increase net spending. Conclusions and Relevance: This economic evaluation estimates that expanded Medicare coverage for GLP-1RAs would increase access and reduce obesity-related comorbidities but impose substantial costs over 10 years. Even with a moderate scenario (5% uptake, 20% adherence, and 30% additional price discount), net spending was still projected to reach $8 billion over a decade, underscoring the need for further price reductions, lower-cost strategies to prevent weight regain, and reductions in spending on low-value care.

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Crossref · 10.1001/jamahealthforum.2025.0905

Cites

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  • Expanded insurance coverage, generic formulations for earlier GLP-1 RAs, and novel oral agents may improve long-term affordability and access.

    “Expanded insurance coverage, the eventual introduction of generic formulations for earlier GLP-1 RAs, and novel oral agents may improve long-term affordability and access.104,105”

    From Weight maintenance after discontinuation of GLP-1 therapies (2026) · cites this paper as [105]

    The Discussion says expanded Medicare coverage could substantially increase access, and the Conclusions call for price reductions to keep treatment affordable. Neither passage identifies generic formulations of earlier GLP-1 RAs or novel oral agents as routes to long-term affordability and access. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • High medication costs and out-of-pocket expenses remain among the most formidable barriers to GLP-1 receptor agonist and SGLT2 inhibitor use, even for insured patients.

    “High medication costs remain among the most formidable barriers to GLP-1 RA and SGLT2i use.”

    From Unequal Access to Evidence-Based Cardiometabolic Therapies: Racial Disparities in SGLT2 Inhibitor and GLP-1 Receptor Agonist Use Among Patients With Type 2 Diabetes and Cardiovascular Disease (2026) · cites this paper as [26]

    The Conclusions (page unavailable) describe affordability and access challenges for GLP-1 receptor agonists, and the Discussion identifies high drug costs. The paper does not address SGLT2 inhibitors, so it supports only the GLP-1 portion of the citing sentence. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 2

  1. Recognition of obesity as a disease H-440.842. American Medical Association. Accessed August 7, 2024. https://policysearch.ama-assn.org/policyfinder/detail/obesity?uri=%2FAMADoc%2FHOD.xml-0-3858.xml
  2. Sachs? R. Proposed rule would expand Medicare and Medicaid coverage for anti-obesity medications. HealthAffairs. December 17, 2024. Accessed December 30, 2024. https://www.healthaffairs.org/content/forefront/proposed-rule-would-expand-medicare-and-medicaid-coverage-anti-obesity-medications

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Metadata

Authors
Hwang, J. H., Laiteerapong, N., Huang, E. S., Mozaffarian, D., Fendrick, A. M., & Kim, D. D.
Affiliations
  • University of Chicago (US)
  • Tufts University (US)
  • University of Michigan (US)
Corresponding author
Kim, David D.
ORCID
Venue
JAMA Health Forum
Publisher
American Medical Association (AMA)
Published
2025-04-25
Volume
6
Issue
4
Pages
e250905
ISSN
2689-0186 (ISSN-L)
DOI
10.1001/jamahealthforum.2025.0905
PMC
PMC12032556
OpenAlex
W4409783245
Cited by
43
References
30
Citations by year
2026: 34 · 2025: 9
FWCI
24.16
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Health Forum (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Knowledge@UChicago (University of Chicago) (submittedVersion)
  • University of Chicago (cc-by)
Funders
  • National Institutes of Health
  • Health Resources and Services Administration (T32 HP42019)
  • National Institute on Aging (K24AG069080)
  • National Heart, Lung, and Blood Institute (R01HL115189)
  • National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092949)
  • National Institute on Minority Health and Health Disparities (R01MD019094)
Topics
  • Health Sciences › Medicine › Pharmacology (medical) › Pharmacology and Obesity Treatment
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Keywords
GLP-1 receptor agonists, obesity treatment, obesity-related comorbidities, Medicare beneficiaries, health policy, health care spending projections, body mass index
MeSH terms
Glucagon-Like Peptide-1 Receptor Agonists, Aged, Cost-Benefit Analysis, Female, Humans, Male, Middle Aged, Obesity, United States, Drug Costs, Medicare Part D

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