Proposal for a Value-Based Agreement to Reimburse Anti-obesity Medicines in Traditional Medicare
Sexton Ward, A.; Trish, E.; Goldman, D.; Lakdawalla, D.
Show abstract
Anti-obesity medicines (AOMs), such as glucagon-like peptide-1 (GLP-1) agonists, hold great promise for slowing the chronic disease epidemic in the United States. Treatment with semaglutide and tirzepatide produces substantial weight loss and significant reductions in obesity-related diseases. Prior research shows expanding access to AOMs would generate trillions of dollars in social value to Americans today in the form of better life expectancy and fewer years spent with chronic diseases. The Medicare program, itself, could save around $245 billion in Part A and Part B spending over 10 years. Despite the potential value, access to GLP-1s for weight loss remains frustratingly low. Medicare and most private insurance plans do not cover the newly approved GLP-1 treatments. This paper presents a payment mechanism to resolve many insurers concerns regarding coverage of GLP-1s. We propose a value-based agreement for Medicare beneficiaries where The Centers for Medicare & Medicaid Services (CMS) pays a lower upfront price and shares the long-term savings with manufacturers if and when they are realized. For simplicity, we use a straightforward reimbursement approach building on Medicares existing risk-adjustment infrastructure to identify savings in treating obesity-related (ICD-10) conditions. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=96 SRC="FIGDIR/small/25331289v1_ufig1.gif" ALT="Figure 1"> View larger version (11K): org.highwire.dtl.DTLVardef@1d124c4org.highwire.dtl.DTLVardef@1c4f728org.highwire.dtl.DTLVardef@3e9c6borg.highwire.dtl.DTLVardef@8f6c52_HPS_FORMAT_FIGEXP M_FIG C_FIG
Matching journals
The top 3 journals account for 50% of the predicted probability mass.
Similar papers in this journal
- Pricing Treatments Cost-Effectively When They Have Multiple Indications: Not Just a Simple Threshold Analysis 91%
- A novel decision modeling framework for health policy analyses when outcomes are influenced by social and disease processes 90%
- Forecasting local surges in COVID-19 hospitalizations through adaptive decision tree classifiers 89%
Similar papers in this journal
- Learning Decision Thresholds for Risk-Stratification Models from Aggregate Clinician Behavior 91%
- Measure what matters: counts of hospitalized patients are a better metric for health system capacity planning for a reopening 91%
- Clinical Utility of Automatable Prediction Models for Improving Palliative and End-Of-Life Care Outcomes: Towards Routine Decision Analysis Before Implementation 90%
Similar papers in this journal
Similar papers in this journal
- The Amortization of Funding Gene Therapies: Making the “Intangibles” Tangible for Patients 92%
- Progressivity of out-of-pocket costs under Australia’s universal health care system: a national linked data study 90%
- A novel methodology to measure waiting times for community-based specialist care in a public healthcare system 89%
"Similar papers" are the closest papers from that journal in the model's embedding space. They show what the match is built on, but the ranking comes mostly from a classifier over the whole training set, not from these examples alone.