About 3.6 million Medicare beneficiaries could be eligible for Wegovy coverage, study shows

[April 24, 2024]  (Reuters) - About 3.6 million overweight or obese patients with heart conditions insured under the U.S. Medicare program could be eligible for coverage of Novo Nordisk's weight-loss drug Wegovy, a study published by Kaiser Family Foundation (KFF) showed on Wednesday.

WHY IT'S IMPORTANT

Wegovy was approved by the U.S. health regulator last month for lowering the risk of stroke and heart attack in overweight or obese adults who do not have diabetes.

The additional approval would expand Medicare coverage for Wegovy and coverage by other insurers for such adults with heart conditions.

Medicare prescription drug plans administered by private insurers, known as Part D, currently cannot cover drugs that are approved solely for obesity.

However, under a new guidance, such drugs would be paid for if they receive U.S. approval for a secondary use that Medicare does cover.

BY THE NUMBERS

The approval would potentially allow just over a quarter of the 13.7 million Medicare beneficiaries diagnosed with heart disease and obesity to use Wegovy, the KFF study showed.

Injection pens and boxes of Novo Nordisk's weight-loss drug Wegovy are shown in this photo illustration in Oslo, Norway, November 21, 2023. REUTERS/Victoria Klesty/Illustration/File Photo

Among the eligible patients, 1.9 million people also had diabetes, according to the study, making them already eligible for Medicare coverage of other drugs like Novo's Ozempic, which has the same active ingredient as Wegovy and is approved for diabetes.

WHAT'S NEXT

While some Part D plans have announced they will begin covering Wegovy this year, a broader coverage could be expected in 2025, the study said.

How the expanded Wegovy coverage will impact Medicare spending will depend in part on how many Part D plans add coverage for it, and the extent to which plans apply restrictions on use like prior authorization.

It would also depend on how many people who qualify to take the drug use it and negotiated prices paid by plans.

(Reporting by Mariam Sunny in Bengaluru; Editing by Varun H K)

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