The Food and Drug Administration’s (FDA) recent approval of Wegovy for reducing cardiovascular disease risk in Medicare beneficiaries with obesity has significant implications for healthcare access and costs. According to a KFF analysis, approximately 3.6 million Medicare beneficiaries, or about 7% of all enrollees, could potentially gain access to the drug. This includes individuals with both obesity and cardiovascular disease diagnoses. Wegovy, a GLP-1 agonist, has been previously approved for treating diabetes and obesity. However, Medicare is currently prohibited from covering weight loss medications due to the Medicare Modernization Act of 2003. Advocates have been calling for the passage of the Treat and Reduce Obesity Act (TROA) to lift this prohibition and expand coverage for obesity medications and related services. The KFF analysis also projected the potential cost implications of covering Wegovy under Medicare Part D. If just 10% of eligible beneficiaries used the drug, Medicare could incur an additional $3 billion in spending. However, the analysis suggests that this cost increase could be partially offset if more Medicare beneficiaries with obesity or overweight gain access to GLP-1s for other approved uses, thereby reducing the need for separate coverage of anti-obesity drugs. Beneficiaries would also incur out-of-pocket costs for Wegovy, ranging from $325 to $430. The FDA’s approval of Wegovy for cardiovascular risk reduction was based on a multinational study conducted by Novo Nordisk, the drug’s manufacturer. The study found that Wegovy reduced the risk of major adverse cardiovascular events, including heart attack and stroke, by 20% in patients with cardiovascular disease and obesity. The exact mechanism of action for this reduction was not established in the study.
Medicare Expansion of Wegovy Coverage: Impact and Implications
