Medicare has recently decided to include coverage for Novo Nordisk A/S’s (NVO) obesity medication, Wegovy (semaglutide), for the treatment of heart disease in overweight individuals.
A new analysis by the Kaiser Family Foundation (KFF) suggests that approximately 3.6 million Medicare beneficiaries could potentially benefit from this decision, accounting for about 7% of all Medicare recipients according to data from 2020.
The FDA approved Wegovy last month to lower the risk of cardiovascular death, heart attack, and stroke in patients with cardiovascular disease and obesity. The approval was based on a study by Novo Nordisk, which demonstrated a 20% decrease in major adverse cardiovascular events.
However, this expanded coverage could lead to Medicare spending close to $3 billion annually and potentially result in increased Part D premiums for all beneficiaries. It is important to highlight that current Medicare prescription drug plans under Part D, which are managed by private insurers, do not cover Wegovy and similar GLP-1 drugs for weight loss purposes alone.
Eligible beneficiaries who opt for Wegovy may be required to contribute a percentage of the drug’s list price for a month’s supply, translating to monthly costs ranging from $325 to $430.
While some Part D plans have indicated their intention to cover Wegovy in the current year, the extent of coverage remains uncertain.
KFF pointed out that many plans may be hesitant to expand coverage at present, as they are unable to adjust premiums midway through the year to accommodate the increased costs associated with the drug’s utilization.
KFF suggested that broader coverage for Wegovy may be more likely in 2025.
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