Study Reveals Potential Eligibility of Medicare Beneficiaries for Wegovy Coverage

The study highlights that many Medicare beneficiaries may be eligible for coverage of Wegovy, a medication used for chronic weight management. This potential expansion of benefits could significantly impact those seeking medical solutions for obesity under Medicare, suggesting a shift in healthcare policies to include more preventive treatments.

April 24 (Reuters) - According to a recent study released by the Kaiser Family Foundation (KFF), approximately 3.6 million Medicare beneficiaries suffering from overweight or obesity alongside heart conditions may qualify for insurance coverage of Novo Nordisk's weight-loss medication Wegovy.

WHY IT'S IMPORTANT

Last month, Wegovy received approval from the U.S. health regulatory body for its efficacy in reducing the risk of stroke and heart attack among overweight or obese adults without diabetes.

The recent approval for Wegovy stands to broaden its coverage under Medicare, as well as under other insurance providers, for individuals with heart conditions. Presently, Medicare Part D, overseen by private insurers, is unable to include medications solely approved for obesity treatment. Nevertheless, with the introduction of new guidelines, medications like Wegovy could be eligible for coverage if they gain U.S. approval for a secondary purpose that Medicare supports.

BY THE NUMBERS

As per the KFF study findings, the approval could potentially grant access to Wegovy for slightly more than a quarter of the 13.7 million Medicare recipients grappling with both heart disease and obesity. Additionally, the study notes that among these eligible individuals, approximately 1.9 million also contend with diabetes, rendering them already eligible for Medicare coverage of alternative medications such as Novo's Ozempic, which shares the same active ingredient as Wegovy and is sanctioned for diabetes treatment.

‍WHAT'S NEXT

According to the study, although certain Part D plans have declared their intention to incorporate Wegovy coverage in the current year, a more comprehensive rollout may be anticipated by 2025. The implications of this expanded Wegovy coverage on Medicare spending will hinge on several factors. These include the number of Part D plans that opt to include coverage for the medication, the level of restrictions imposed on its use, such as prior authorization requirements, the uptake rate among eligible individuals, and the negotiated prices agreed upon by the plans.

Source: Reuters