“we find no impact of debt relief on credit access, utilization, and financial distress on average. Second, we estimate that debt relief causes a moderate but statistically significant reduction in payment of existing medical bills.”

nber.org/papers/w32315?…

I'll wager that answer was 'no'

Given Medicare's power, the back and forth element of this process has always seemed a bit theatrical

New analysis w/ Loren Adler looks at early results from the No Surprises Act arbitration process.

In short: the prices emerging are quite high, and there is a real chance that the law will raise prices/premiums, not reduce them as CBO predicted.

brookings.edu/articles/a-fir…

As usual, this type of analysis of gross spending from KFF results in plainly misleading news coverage. It is trivial to produce better estimates of spending (which are still high!) and yet the cycle continues

I'd guesstimate that Medicare's net spending on these drugs roughly doubled in 2023. So net spending in the ballpark of $6 billion

(Novo reported that Ozempic/Rybelsus U.S. net sales nearly doubled from 2022 to 2023. Mounjaro increased at a faster rate.)

Given that close to 30% of Medicare enrollees have diabetes, I wouldn't have been surprised if spending was higher than this by 2022 (which translates to $2-3B in actual spending)

Medicare plans *can* cover Wegovy for some patients, but it's not clear how many will (or how easy access will be)

The next administration will essentially choose the price of Ozempic in Medicare. Hard to imagine a more salient, consequential, and politically charged use of its new power

Worth keeping in mind that many more obese have access to Ozempic/Wegovy etc... because of the diabetes indication than because of a new cardiovascular (even if cardio version was covered widely)

Somewhat confusingly this seems to propose policies that have already passed Congress? (FWIW they were the subject of some bipartisan agreement)

'Other reforms should include eliminating the coverage gap in Part D, reducing the government share in the catastrophic tier...'

This is worth a listen for a much more accurate picture of how antiobesity drugs will affect Medicare spending than some recent analysis

Evaluating Medicare negotiation *as written* was never relevant for much more than near-term outlooks.

Regardless, this seems like a moment to learn from a policy change before plowing ahead

I've been fairly deep in GLP-1 budget math recently and am confident that:

1) The cost of anti-obesity drugs won't be in the same universe as $1 trillion/yr.

2) This will be very clear when CBO estimates costs to Medicare (which they've probably already signaled to the Hill).