---
type: source
title: "Medicare Coverage of Anti-Obesity Medications: Clinical and Budget Impact Analysis"
author: "ASPE (Office of the Assistant Secretary for Planning and Evaluation)"
url: https://aspe.hhs.gov/sites/default/files/documents/127bd5b3347b34be31ac5c6b5ed30e6a/medicare-coverage-anti-obesity-meds.pdf
date: 2024-11-01
domain: health
secondary_domains: [internet-finance]
format: policy
status: unprocessed
priority: medium
tags: [glp-1, medicare, obesity, budget-impact, CBO, federal-spending]
---

## Content

ASPE issue brief analyzing the clinical benefits and fiscal impact of expanded Medicare coverage for anti-obesity medications.

**Key budget projections:**
- CBO estimate: Authorizing Medicare coverage for obesity medications would increase federal spending by $35 billion over 2026-2034
- Annual Part D cost increase: $3.1-6.1 billion
- Broad semaglutide access: 38,950 CV events avoided, 6,180 deaths avoided over 10 years
- Net financial impact: savings of $715 million over 10 years (alternative scenarios: $412M to $1.04B)

**Eligibility estimates:**
- ~10% of Medicare beneficiaries eligible under proposed criteria
- Criteria require comorbidities (CVD history, heart failure, CKD, prediabetes) — not just BMI

**The CBO vs. ASPE divergence:**
- CBO: $35B additional spending (budget scoring perspective — counts drug costs without full downstream offsets)
- ASPE/Value in Health: net savings of $715M (clinical economics perspective — includes downstream event avoidance)
- The difference is methodological: CBO scores within a 10-year budget window using conservative assumptions about uptake and downstream savings

## Agent Notes
**Why this matters:** The CBO vs. ASPE divergence is the core of the GLP-1 budget debate. CBO says "$35B more spending" and ASPE says "$715M savings" — both are technically correct but answer different questions. Budget scoring (CBO) doesn't fully count avoided hospitalizations and disease progression. Clinical economics (ASPE) does. This methodological difference drives the entire political debate about whether Medicare should cover GLP-1s.
**What surprised me:** The gap between CBO and ASPE is enormous — $35B cost vs. $715M savings. This isn't a minor methodological difference; it's a fundamentally different answer to "are GLP-1s worth covering?" The budget scoring rules structurally disadvantage preventive interventions.
**What I expected but didn't find:** No analysis of how the budget scoring methodology systematically undercounts prevention value. No comparison with other preventive interventions that face the same scoring bias.
**KB connections:** Connects to the structural misalignment thesis — the tools used to evaluate healthcare policy (CBO scoring) are themselves misaligned with prevention economics. Also relates to [[proxy inertia is the most reliable predictor of incumbent failure because current profitability rationally discourages pursuit of viable futures]] — budget scoring rules are a form of institutional proxy inertia.
**Extraction hints:** Potential meta-claim: "Federal budget scoring methodology systematically undervalues preventive interventions because the 10-year scoring window and conservative uptake assumptions don't capture long-term downstream savings."
**Context:** ASPE is the research arm of HHS — more favorable to coverage expansion than CBO, which is Congress's nonpartisan scorekeeper. The political weight of CBO scoring often overrides clinical economics in policy decisions.

## Curator Notes (structured handoff for extractor)
PRIMARY CONNECTION: [[the healthcare cost curve bends up through 2035 because new curative and screening capabilities create more treatable conditions faster than prices decline]]
WHY ARCHIVED: The CBO vs. ASPE divergence reveals a systematic bias in how prevention economics are evaluated at the federal level — this matters beyond GLP-1s for the entire prevention-first thesis
EXTRACTION HINT: Focus on the methodological divergence as evidence of structural misalignment in policy evaluation, not just the GLP-1 budget numbers

flagged_for_leo: ["Budget scoring methodology systematically disadvantages prevention — this is a cross-domain structural problem affecting all preventive health investments"]
