More than 3 million people with Medicare could be eligible for coverage of Wegovy now that the popular weight loss drug is also approved in the U.S. for heart health, according to an analysis by health policy research organization KFF.
KFF said that applies to 3.6 million, or 7%, of total beneficiaries, based on 2020 data. That group also makes up 1 in 4 of the 13.7 million Medicare patients who are obese or overweight. Those numbers may be higher based on more recent data, the nonprofit group said.Notably, Medicare prescription drug plans administered by private insurers, known as Part D, currently cannot cover Wegovy and other GLP-1 drugs for weight loss alone.
A new Part D cap on out-of-pocket spending would limit beneficiaries' out-of-pocket costs to around $3,300 in 2024 and $2,000 in 2025. Still, those sums are a significant burden for those who live on modest incomes. "These factors could have a dampening effect on use by Medicare beneficiaries, even among the target population," KFF wrote in its analysis.KFF said many plans may be reluctant to expand coverage now since they can't adjust their premiums mid-year to account for higher costs associated with use of the drug.Medicare already covers GLP-1s and other treatments for diabetes, such as Novo Nordisk's blockbuster Ozempic.
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