According to recent reports, more than 3 million people with Medicare could potentially be eligible for coverage of Wegovy, a newly approved weight loss drug that has been shown to benefit heart health. However, some eligible beneficiaries may still face out-of-pocket costs for the pricey medication, as certain Medicare prescription drug plans may delay coverage until 2025.
The potential influx of Medicare coverage for Wegovy could strain the program’s budget, with estimates suggesting that prescription drug plans could spend an additional net $2.8 billion if just 10% of the eligible population were to use the drug for a full year. Despite this, Medicare Part D plans have the ability 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.
While Medicare beneficiaries may still have to pay monthly out-of-pocket costs for Wegovy, there is a new Part D cap on out-of-pocket spending in place. Some Part D plans have already announced that they will begin covering Wegovy this year, although broader coverage may not be widespread until 2025 due to concerns over the drug’s cost.
It is worth noting that Medicare already covers other GLP-1 drugs and treatments for diabetes, potentially making many beneficiaries eligible for coverage of Wegovy. As more and more Medicare beneficiaries explore the option of using Wegovy for weight loss and heart health benefits, the program will likely face financial challenges in providing coverage for this innovative medication.
