Medicare Coverage for Weight Loss Drug Wegovy Raises Cost Concerns
More than 3 million people with Medicare may be eligible for coverage of Novo Nordisk’s weight loss drug Wegovy, which has recently been approved in the U.S. for heart health. However, some eligible beneficiaries may still face out-of-pocket costs for the expensive drug, with certain Medicare prescription drug plans potentially delaying coverage until 2025.
The potential strain on Medicare’s budget is a concern, as more plans begin to cover Wegovy. It is estimated that there could be an additional $2.8 billion in costs if 10% of the eligible population uses the drug for a year. Medicare Part D plans can cover Wegovy for obese or overweight patients with a history of heart disease to reduce their risk of heart attacks and strokes.
Around 3.6 million Medicare beneficiaries could be eligible for Wegovy, making up 1 in 4 of patients who are obese or overweight. While beneficiaries taking Wegovy may still face monthly out-of-pocket costs, there is a new cap on out-of-pocket spending that is set to be implemented in 2024 and 2025.
Some Part D plans have already announced coverage of Wegovy, but wider coverage may not come until 2025, as plans may be reluctant to expand coverage mid-year. Medicare already covers other GLP-1 drugs for diabetes, with 1.9 million beneficiaries eligible for coverage of these drugs due to having both obesity/overweight and a history of heart disease.
The potential impact of Medicare covering Wegovy on the overall healthcare system remains to be seen, as access to this innovative treatment could greatly benefit those struggling with obesity and heart disease. Stay tuned for updates on this evolving story.
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