Comprehensive Access to Semaglutide: Clinical and Economic Implications for Medicare.

Objectives: The objective of this study was to estimate comprehensive value of semaglutide in the Medicare population for current and future FDA-approved indications.

Methods: We used data from government reports, published clinical studies, and real-world claims to model clinical outcomes and costs in patients with diabetes, overweight/obesity, and metabolic-associated steatohepatitis over a 10-year period (2026 to 2035). We estimated the financial impact to the Medicare program by comparing the impact of costs of averted clinical events and anticipated treatment costs under various treatment utilization and price assumptions with a scenario in which no patients were treated with semaglutide. We used estimates of the net price of semaglutide, an estimated negotiated price based on a 10% discount from net price starting in year 2, and accounted for patient out-of-pocket costs.

Results: Over the 10-year period, we estimated that broad access to semaglutide would result in 38 950 cardiovascular events avoided, and 6180 deaths avoided due to reduction in cardiovascular events and improvement in chronic kidney disease or metabolic-associated steatohepatitis progression. The net financial impact to Medicare was estimated to be savings of $715 million over 10 years. Alternative scenarios yielded net savings ranging from $1.04 billion to $412 million. A scenario that accounted for loss of exclusivity of semaglutide and other treatments produced 10-year cost savings to Medicare of approximately $1.71 billion.

Conclusions: Availability of semaglutide in Medicare for all FDA-approved indications would have a substantial impact on health outcomes at net savings of between $1.04 billion and $412 million over 10 years.