Expanding semaglutide access in Medicare: modeling shows billions in health gains and potential cost savings

A landmark economic evaluation published in Value in Health (October 2025) by Dayer et al. quantified the long-term clinical and financial impact of broad semaglutide access within the Medicare population, encompassing current and anticipated FDA-approved uses — type 2 diabetes (T2D), obesity, and metabolic-associated steatohepatitis (MASH). Using real-world claims, government data, and published clinical outcomes, the study modeled 10-year outcomes (2026–2035) comparing semaglutide coverage to standard care.

Assuming implementation of Medicare drug price negotiations (with a 10–20% discount from net price beginning in 2027), the model projected substantial health benefits:

• 38,950 cardiovascular events avoided, including ~3,800 cardiovascular deaths;
• 2,330 fewer CKD-related deaths and 1,820 fewer new cases of sleep apnea;
• 7,900 fewer knee replacements and reduced progression of MASH-related disease.

Under base-case assumptions, semaglutide access would yield $715 million in net Medicare savings over 10 years. Savings increased to $1.04 billion with deeper negotiated discounts and to $1.71 billion when factoring in generic entry (expected by 2032). Scenario analyses across utilization rates consistently favored semaglutide, showing savings between $412 million and $1.02 billion while maintaining major cardiovascular and renal benefits.

The most pronounced cost reductions arose in the T2D and MASH populations, where lowered event rates and disease progression outweighed treatment costs. While coverage expansion for obesity alone modestly increased expenditures, those costs were offset by reduced diabetes incidence and comorbidity burden.

The findings contrast with earlier Congressional Budget Office projections estimating tens of billions in new spending if Medicare covered anti-obesity drugs, due to differing assumptions around pricing, uptake, and cross-condition benefits. The present analysis integrates multi-condition overlap—acknowledging that metabolic diseases coexist and interact—and accounts for negotiated prices, positioning semaglutide as a net value generator rather than a cost driver.

Limitations include uncertainty in long-term adherence, real-world uptake, and exclusion of potential secondary benefits such as reduced insulin use or lower bariatric surgery demand. Nevertheless, the results strongly suggest that comprehensive semaglutide access across indications could improve longevity and reduce healthcare costs for millions of older adults.

#Semaglutide #HealthEconomics #Medicare #Obesity #Type2Diabetes

Editorial Note

This text was organized with the support of artificial intelligence, but it was critically reviewed and validated by a qualified professional to ensure scientific accuracy and reliability.