Lawrenceville, NJ, USA—October 14, 2025—Value in Health, the official journal of ISPOR—The Professional Society for Health Economics and Outcomes Research, announced today the publication of a landmark study by researchers at the University of Washington, Curta, Inc, and the University of North Carolina showing that broad Medicare coverage of semaglutide in diabetes, obesity, and liver disease could generate significant cost savings while delivering substantial health benefits to beneficiaries. The report, “Comprehensive Access to Semaglutide: Clinical and Economic Implications for Medicare,” was published in the October 2025 issue of Value in Health.
“Our findings suggest that the potential clinical value of semaglutide in the Medicare population is substantial,” said author Victoria W. Dayer, PharmD, The CHOICE Institute, School of Pharmacy, University of Washington, Seattle, WA, USA and Curta, Inc, Seattle, WA, USA, “Additionally, comprehensive access could result in net savings to Medicare of hundreds of millions of dollars.”
Key findings
- Health outcomes: 38,950 fewer cardiovascular events; approximately 6180 fewer deaths (cardiovascular, chronic kidney disease-progression-related, and metabolic dysfunction-associated steatohepatitis [MASH]-related) compared with no semaglutide access
- Cost impact: Base-case net savings of $715 million to Medicare over 10 years, reflecting about $5.15 billion in disease-related costs averted and $4.44 billion in treatment costs
- By indication: Net savings in type 2 diabetes (about $892 million) and MASH (about $28 million); net cost in obesity (about $205 million) over 10 years
- Scenario analyses: Savings ranged from $412 million to $1.02 billion under alternative obesity uptake assumptions; estimated $1.04 billion in savings with a 20% negotiated price reduction starting in year 2; and approximately $1.71 billion in savings when accounting for loss of exclusivity and generic entry
The research examined semaglutide access for Medicare beneficiaries with type 2 diabetes, overweight/obesity, and MASH from 2026 to 2035. The authors utilized Medicare claims data, published clinical studies, and government reports to model outcomes including cardiovascular events, chronic kidney disease progression, sleep apnea development, and knee replacements. The analysis incorporated a 10% discount from net price as the estimated Maximum Fair Price for semaglutide starting in 2027, based on Medicare's drug price negotiation program.
Unlike previous studies that focused on specific policy changes such as expanding obesity coverage, this analysis took a comprehensive approach examining current and anticipated future US Food and Drug Administration-approved indications while incorporating upcoming negotiated pricing. The study also accounted for the reduced risk of developing type 2 diabetes among obesity patients treated with semaglutide, providing additional cost offsets.
"This work provides evidence of the substantial clinical benefits of semaglutide in the Medicare population to be used for policy decision making," the authors noted in their conclusion. Broader access would prevent thousands of cardiovascular events and deaths, with the savings from avoided disease-related costs exceeding the treatment expenses. This analysis provides evidence that expanding semaglutide coverage represents an opportunity to simultaneously improve patient outcomes and reduce Medicare spending.
Further Reading
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ABOUT ISPOR
ISPOR—The Professional Society for Health Economics and Outcomes Research (HEOR), is an international, multistakeholder, nonprofit dedicated to advancing HEOR excellence to improve decision making for health globally. The Society is the leading source for scientific conferences, peer-reviewed and MEDLINE®-indexed publications, good practices guidance, education, collaboration, and tools/resources in the field.
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ABOUT VALUE IN HEALTH
Value in Health (ISSN 1098-3015) is an international, indexed journal that publishes original research and health policy articles that advance the field of health economics and outcomes research to help healthcare leaders make evidence-based decisions. The journal’s current impact factor score is 6.0 and its 5-year impact factor score is 5.7. Value in Health is ranked 5th of 124 journals in Health Policy and Services, 12th of 185 journals in Health Care Sciences & Services, and 37th of 617 journals in Economics. Value in Health is a monthly publication that circulates to more than 55,000 readers around the world.
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