Overview
- CMS data show Medicare Part D claims for GLP-1 drugs rose from 4.8 million in 2019 to 21.8 million in 2024, with gross spending reaching $27.5 billion and estimated net costs likely far lower after sizable rebates.
- Two million Part D enrollees used semaglutide branded as Ozempic in 2024, up from fewer than 150,000 in 2019, while Mounjaro also saw rapid growth in use.
- CMS plans to launch the voluntary BALANCE model to broaden access to GLP-1s for weight management, starting in 2026 for Medicaid and in 2027 for Medicare, with manufacturers, states, and Part D plans opting in.
- Drug-pricing agreements negotiated with the administration are expected to open Medicare coverage for obesity medicines later this year, with certain patients paying about $50 per month for approved GLP-1 therapies.
- Eli Lilly CEO Dave Ricks said the company expects Medicare coverage immediately following the Q2 launch of its oral obesity pill orforglipron, as Novo Nordisk’s new GLP-1 pill sees strong early uptake with many patients paying cash.