If you’re one of the millions of Medicare beneficiaries who are overweight or obese and have a history of heart disease, there is exciting news for you. Recently, the FDA approved Wegovy, a groundbreaking weight loss drug from Novo Nordisk, for heart health. This means that more than 3 million people with Medicare could now be eligible for coverage of Wegovy, according to a recent analysis by the health policy research organization KFF.
However, while this news is undoubtedly positive, some eligible beneficiaries may still face out-of-pocket costs for this highly popular and expensive drug. In fact, certain Medicare prescription drug plans may not cover Wegovy until 2025, leaving some beneficiaries to shoulder the full $1,300 monthly price tag on their own.
On a broader scale, Medicare’s budget could feel the strain as more plans start covering the costs of Wegovy. According to KFF, if just 10% of the eligible population – an estimated 360,000 people – use the drug for a full year, Medicare prescription drug plans could spend an additional net $2.8 billion. This underscores the potential financial impact that widespread coverage of Wegovy could have on the program.
But there is hope on the horizon for Medicare beneficiaries looking to access Wegovy. Under new guidance issued in March, Medicare Part D plans now have the option to cover Wegovy for patients who are obese or overweight, have a history of heart disease, and are specifically prescribed the weekly injection to reduce their risk of heart attacks and strokes. This is a significant development as it marks the first time that certain Medicare beneficiaries will be able to access Wegovy without shouldering the full cost on their own.
Despite this positive news, there are still challenges to overcome. Medicare beneficiaries who take Wegovy may still face monthly out-of-pocket costs ranging from $325 to $430 if they have to pay a percentage of the drug’s list price for a month’s supply. Additionally, some Part D plans may implement requirements such as “step therapy” to control costs and ensure the drug is being used appropriately, which could limit access for some beneficiaries.
Overall, the approval of Wegovy for heart health represents a step forward for Medicare beneficiaries looking to manage their weight and reduce their risk of heart disease. As more plans start covering the drug and individuals gain access to this innovative treatment, the landscape of healthcare for overweight and obese individuals with a history of heart disease is shifting. Stay tuned for updates on how this development will shape the future of Medicare coverage and access to cutting-edge treatments like Wegovy.
