Medicare has announced it will cover the medication Wegovy for patients at higher risk of cardiovascular issues like heart attacks and strokes. This decision could enable access to this costly but effective weight loss drug for millions.
Traditionally, Medicare, serving over 65 million Americans, hasn’t covered weight loss medications. However, the recent FDA approval expansion for Wegovy, to include its use for reducing heart disease risks in overweight or obese individuals, led to this policy change. While Medicare will cover Wegovy for heart disease risk reduction, it won’t cover it solely for weight management.
Similarly, Medicaid, the federal program for low-income individuals, is also required to cover Wegovy for heart disease risk reduction.
Lawrence Gostin from Georgetown University sees this as a transformative step for Medicare. However, he warns of potential financial challenges for Medicare, citing Wegovy’s high cost of approximately $1,200 a month. A University of Michigan survey indicated strong support among older adults for Medicare to cover weight loss drugs, while a Congressional Budget Office blog post last year highlighted significant potential costs to Medicare over the next decade if such drugs are covered.
Gostin expressed concerns about a possible scenario where Medicare might end up covering Wegovy for weight loss, which could strain its finances and cause public backlash.
Juliette Cubanski of KFF notes that many individuals with heart disease are overweight or obese, suggesting that these patients might get Medicare coverage for Wegovy for its heart health benefits. Given the high demand for Wegovy, even without broad insurance coverage, this could be significant.
The drug will fall under Medicare Part D, which handles home medication costs. The response of private insurance companies offering Part D supplemental coverage remains uncertain, especially due to Wegovy’s cost, and they might hesitate to be the first to cover it.