Healthy Returns: Covering weight loss drugs could cost Medicare $35 billion through 2034

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Good afternoon and happy Tuesday! To no surprise, expanding Medicare coverage of costly weight loss drugs could come at a steep cost for the federal government. 

Allowing Medicare to cover obesity medications would increase federal spending by about $35 billion from 2026 to 2034, according to an analysis released by the U.S. Congressional Budget Office last week. 

The federal costs for covering those drugs would grow from $1.6 billion in 2026 to $7.1 billion in 2034, the CBO said. 

The analysis is all hypothetical, and comes as drugmakers and advocacy groups push for the government to expand coverage of – and give more seniors access to – the highly popular treatments. Those include GLP-1s for obesity such as Novo Nordisk's Wegovy and Eli Lilly's Zepbound, which both carry hefty price tags of roughly $1,000 per month before insurance and other rebates. 

Right now, Medicare doesn't cover weight loss treatments unless they are approved and prescribed for another health condition. For example, Medicare covers Wegovy for reducing the risk of serious cardiovascular complications in those with heart disease and obesity, but doesn't cover the drug for weight loss.  

The CBO expects that savings from improved health among patients – mainly by reducing the incidence of obesity-related conditions – will grow over time. Still, it says those savings could be relatively small, totaling less than $50 million in 2026 and about $1 billion in 2034.

"Even though net federal savings per user are projected to be larger over the longer term, they would still be less than the cost of the medications," the CBO said in the report.

The cost of drugs could also fall over time, according to the CBO.  

Here's why: It expects generic versions of popular weight loss injections to enter the market and reduce prices. The CBO also anticipates average net prices for obesity medications will fall in 2027 due to Medicare drug price negotiations with manufacturers.

Semaglutide, the active ingredient in Wegovy and Novo Nordisk's diabetes drug Ozempic, could be among the 15 prescription drugs selected for the next round of price talks, which will begin in 2025 and go into effect in 2027. 

But how could Medicare coverage of those treatments impact access? 

If Medicare covers those medications, more than 12.5 million beneficiaries would newly qualify for weight loss drugs beginning in 2026, according to the CBO. The analysis said around 2% of those patients are expected to use the treatments in the first year. 

More than two-thirds of Medicare beneficiaries are classified as either obese or overweight, according to their body mass index, the CBO said. 

Notably, spending could look slightly different beyond 2034. 

The CBO said Medicare spending on weight loss drugs would probably be lower on a per-user basis due to lower costs tied to the drugs and increasing savings. But Medicare coverage of those treatments would still increase net federal costs from 2034 to 2044, the CBO noted. 

A Novo Nordisk spokesperson said in a statement Tuesday that the medical and societal costs of obesity are "significant," with some estimates exceeding $1.7 trillion annually in the U.S. 

"We know treatment of obesity is linked to better medical outcomes, even if bureaucrats haven't figured out how to account for these savings," the spokesperson said, adding that the company hopes Medicare will start to offer coverage for weight loss drugs. 

Eli Lilly did not immediately respond to CNBC's request for comment. 

Feel free to send any tips, suggestions, story ideas and data to Annika at annikakim.constantino@nbcuni.com.

I've been testing Abbott Laboratories' consumer-friendly continuous glucose monitor for the last few weeks, and it's a slick new tool for people who want an in-depth view into how their metabolism works. 

The device is called Lingo, and it's a small sensor that pokes through the skin to measure real-time glucose levels. It's very comfortable and easy to use. I'm wearing one on the back of my right arm, and I forget that it's there most of the time.  

I've tried continuous glucose monitors before, but this was my first time testing one from Abbott. The company launched Lingo in September, just after its competitor Dexcom announced its own consumer-facing monitor called Stelo in late August. I reviewed Stelo for CNBC ahead of that launch. 

There are a lot of similarities between Lingo and Stelo, but Abbott's app provides a much more comprehensive look into your glucose data over time than Dexcom's does. If you're interested in exploring your metabolism on a more granular level, Abbott's system is probably the better product for you. 

Glucose is a sugar molecule that comes from food, and it's our bodies' primary source of energy. Everyone's glucose levels vary, but people can develop serious health problems like metabolic disease, insulin resistance and heart disease if their levels are consistently high. Lingo aims to help educate users about their habits and teach them to manage their glucose in healthier ways, according to Abbott.

Continuous glucose monitors have historically been prescribed to patients with diabetes, but Lingo is intended for adults like me who do not have the disease. It's available without a prescription, so you can pay out of pocket and buy one sensor online for $49, two for $89 or six for $249. 

Dexcom's Stelo is also available over the counter, and an ongoing subscription for two sensors costs $89 a month. Stelo sensors last up to 15 days before they need to be replaced, and Lingo sensors last up to 14 days.

Once your Lingo sensors arrive, it's pretty simple to start using them. I downloaded the Lingo app, entered some basic biological information and prepared to apply the sensor to my arm. The app walks you through each step, and it's easy to follow. 

I started by putting together my applicator, the tool that inserts the sensor into the upper arm. There's a needle in the applicator, but a flexible filament ultimately sits under the skin below the sensor itself.     

I'm not typically nervous about needles, but I had to hype myself up a bit to apply Lingo. You have to stamp the applicator firmly onto the back of your arm, so it was a little intimidating to do it myself. To apply Stelo with Dexcom's applicator, I just had to click a button.  

I eventually built up the courage to stamp on my sensor, and it really wasn't anything to be nervous about. I did feel some pain, but it subsided after about 10 minutes. When my 14 days were up and it was time to replace my sensor, I felt much more comfortable the second time around. 

Lingo is really easy to wear. I don't notice the sensor while I'm sleeping, and I'm able to wear all my usual clothes with it on. I would just recommend a little caution while pulling on long sleeves so it doesn't snag. To remove the sensor, you peel it off like a Band-Aid.

The sensor takes an hour to warm up, and then it begins transmitting your real-time glucose levels to the Lingo app. One of Abbott's primary goals is to help users learn about glucose spikes, and this is where the app really shines. 

Glucose spikes occur when the amount of sugar present in the bloodstream rapidly increases and then decreases. They commonly occur after eating, but they can also be caused by stress, exercise and other factors. Limiting spikes and improving glucose management can help users improve their sleep and mood, manage their weight and be proactive about their future health, according to Abbott.

To help users conceptualize the impact of their spikes, the company created a metric called the "Lingo Count." It's an algorithm that assigns a numeric value to each glucose spike, and it's supposed to represent how significant the impact is. 

Over each day, users have a target Lingo Count that they want to aim to stay below, and it adjusts to your body with time. My Lingo Count target was 60 initially, and now it's 44. 

It's a really helpful way to conceptualize the impact that your diet has on your body. For instance, when I ate a vanilla greek yogurt, it added 5 points to my Lingo Count, and when I had a few pieces of candy, it added 14. It's almost intuitive, but it really helps reinforce those healthy habits in my mind. I haven't managed to stay below my target every day, but I do have a much better understanding of why that's the case, and what I can work on. 

I also liked that I could go deeper into my Lingo Count data. Users can look at their Lingo Count over the course of a week, a month or all time. It also shows you what time of day you tend to experience the biggest spikes, which is usually the evening in my case. 

In order to get the most out of Lingo Count, you need to log your meals and exercise in the app. This is mostly straightforward, but the app does glitch from time to time. I often have to tap the entry boxes repeatedly before it will let me type or make a selection, but it always works for me eventually.  

Lingo Count is the crown jewel of the Lingo experience, but there are also a lot of other nice features in the app. For instance, Abbott has a tab full of challenges to help educate users and keep them engaged as they go through their day. 

The challenges are fun, and they usually involve small changes that you can make to help reduce glucose spikes. You can decide how many days each challenge lasts. One challenge I completed encouraged me to close down my kitchen after dinner to avoid late night snacks. This week, I'm challenging myself to drink three liters of water a day. 

Abbott also has lots of articles, videos and recipes available to Lingo users in the discover tab. I recommend going through these, especially if you're new to glucose management. I think the company does a nice job explaining glucose in plain language. 

I'm not great at eating a balanced breakfast, so I tried some of Abbott's recipes for omelets and overnight oats. I'll definitely return to many of these in the future. 

On the whole, I've really enjoyed my experience with Lingo, and it's a tool that I'd definitely recommend to family and friends. It's easy to use and wear, and Lingo Count has helped me better understand how my dietary choices impact my body over time. 

Feel free to send any tips, suggestions, story ideas and data to Ashley at ashley.capoot@nbcuni.com.