OCAN Statement Correcting Bloomberg’s April 2 Coverage with New JAMA Study Findings

"A new JAMA study analyzing the fiscal impact of the Medicare BALANCE program suggests that negotiated drug pricing could significantly expand patient access without increasing net federal spending. The study highlights that the negotiated $245 monthly price for semaglutide—a sharp reduction from current costs—creates enough internal savings to potentially offset the cost of treatment for anywhere from 550,000 to 3.6 million additional beneficiaries. The analysis models various scenarios based on how many eligible seniors utilize the medication and savings generated by the program could fully cover the costs of treatment - even if utilization ranges between 4 percent and 30 percent of the eligible population. 

At a modest utilization rate of 10 percent, the analysis suggests the program's savings would effectively pay for beneficiaries’ treatment, making expanded obesity coverage a financially viable reality for Medicare. These findings indicate that the BALANCE Model’s pricing strategy transforms obesity treatment from a high-cost issue into a sustainable, self-offsetting initiative for older Americans." 

Click here for the JAMA study. For the Bloomberg report, click here.