Wegovy, a weight loss drug manufactured by Novo Nordisk, has recently been approved by the U.S. for heart health benefits as well. This approval now opens up the possibility for more than 3 million people with Medicare to be eligible for coverage of Wegovy. However, despite this positive development, some beneficiaries may still face out-of-pocket costs for the expensive drug.
Medicare’s budget could potentially be strained as more plans begin to cover the drug, with estimates suggesting an additional $2.8 billion in spending if 10% of the eligible population uses Wegovy for a full year. New guidance has allowed Medicare Part D plans to cover Wegovy for overweight or obese patients with a history of heart disease, who have been prescribed the drug to reduce their risk of heart attacks and strokes.
While some beneficiaries may still face monthly out-of-pocket costs for Wegovy, even with a new Part D cap on spending, there are concerns that certain plans may implement requirements to control costs and limit access to the drug for some beneficiaries. While some plans have already started to announce coverage for Wegovy, it may not be widely available until 2025 as premiums cannot be adjusted mid-year.
It is worth noting that Medicare already covers other GLP-1 drugs and treatments for diabetes, which makes many beneficiaries eligible for coverage of Wegovy. Despite potential challenges with coverage and costs, the approval of Wegovy for heart health marks a significant milestone in the fight against obesity and related health issues for Medicare beneficiaries. Stay tuned for more updates on the coverage and availability of Wegovy on Matzav Blog.
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