We’ve all known that person—or maybe we’ve been that person—who avoids going to the dentist at all costs. When a molar on the right side of their mouth starts bothering them when they chew, they just take bites with the left side. Then, when a tooth on the left side starts to hurt, they start to chew in the middle with their front teeth, like beavers. Finally, though, the pain becomes too much, and they drag themselves—or are dragged—kicking and screaming to the dentist’s chair.
I bring this up because this may be the point we’re at with drug prices in the United States. The obesity drug Wegovy might be that final, stabbing pain that forces the issue and makes drug companies sit down and negotiate prices with the government.
We’ve reached this point because last month the FDA approved Wegovy for the reduction of the risk for heart attacks, strokes and other cardiovascular events for overweight or obese adults. This broader approval, which skirts the ban on Medicare paying for obesity medication, sets the stage for the Centers for Medicare and Medicaid Services reimbursing for the use of the drug.
This could be a boon for patients, but a potential budget nightmare for the health-care system since, as it stands now, a prescription for Wegovy averages about $1,350 per month in the United States. If all of the adults with obesity (who, presumably, are also at risk for cardiovascular issues), were put on Wegovy, the cost would exceed the entire Medicare Part D budget.1 As this column often does, we like to comment on how exorbitant spending in one aspect of the government and/or Medicare might ultimately impact ophthalmologists’ reimbursement, since there’s only so much of the budget to go around. In the case of Wegovy possibly getting CMS’ coverage for this broader indication of cardiovascular risk, this could pose the threat of even deeper cuts to surgery in an effort to make up any shortfall.
It looks like this potential budget buster is what may bring the government and drugmakers to the table to try to agree on a lower price for the medication, to both allow patients to have access to the drug while also easing the economic burden. I’m hopeful that a lower price could work, since it seems very viable in Europe. There, a monthly dose of Wegovy is just $328 in Germany and only $296 in the Netherlands.2 So, it is possible. Plus the drug manufacturers would still be making a good amount just based on the volume of patients in the United States.
The other potential positive in terms of curbing the cost of the drug is that, as one article points out, not all patients will need to be switched from their current statin medication if they’re getting acceptable results.
Let’s hope the drug manufacturers can see the wisdom in providing these drugs for more patients, at the cost of a bit less per case and are willing to negotiate. If they do, in the end, both they and the country can come out winners.
— Walter Bethke
Editor in Chief
1. Chen E. Covering new weight loss drugs could strain Medicare, policy experts warn. https://www.statnews.com/2023/03/11/new-weight-loss-drugs-wegovy-medicare/ Accessed March 18, 2024.
2. Health System Tracker. https://www.healthsystemtracker.org/brief/prices-of-drugs-for-weight-loss-in-the-us-and-peer-nations/#List%20prices%20of%20drugs%20used%20for%20weight%20loss%20in%20the%20U.S.%20and%20peer%20nations. Accessed March 18, 2024.
