Yesterday we went through the updated reimbursement prospects for GLP-1 drugs, especially Wegovy in light of its recent label expansion. A thread running through payment policy is the ongoing tension between the Centers for Medicare & Medicaid and the Food and Drug Administration. The FDA is doing what it has always done - reviewing drugs for safety and efficacy - while the former is obligated to the White House to demonstrate that drug prices are coming down in the wake of the Inflation Reduction Act.
In a slight paradigm shift - historically the purse strings have been wide open at Medicare and Medicaid in the wake of an FDA drug approval - evidence is becoming more important on a relative and historic basis. That is most true in the context of a high priced, high profile drug like Wegovy.
Replay here.
After that call the Congressional Budget Office, at an event sponsored by an obesity advocacy organization, said that the evidence was not yet developed to justify an offsetting cost savings for the Treat and Reduce Obesity Act, which would extend Medicare coverage to anti-obesity medications. Slide deck here. They conceded that outside the 10-year budget window, savings may exists. (The House is considering a bill that would extend the budget window to 30-years.)
Let me know if you have any questions.
Emily Evans
Managing Director – Health Policy
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