April 24, 2024
Philly Voice staff/Philly Voice
Approximately 3.6 million people on Medicare who are obese or overweight and have heart disease may be eligible for coverage of Wegovy after the FDA's recent approval of the popular weight-loss drug for use against heart attack or stroke.
Now that the Food and Drug Administration has approved the use of a popular weight-loss drug for reducing risk of heart attack and stroke, approximately 3.6 million Medicare recipients may be getting access to it, according to a new analysis.
Medicare is prohibited from covering the cost of Wegovy (semaglutide), a blockbuster weight-loss drug, specifically for obesity. But last month, the FDA approved its use for reducing the risk of heart attack, stroke and cardiovascular death in adults diagnosed as obese or overweight who also had cardiovascular disease.
With this new approval, and the drug's possible dual use, millions of people on Medicare may be able to start accessing Wegovy, according to a new KFF analysis.
Among the approximately 13.7 million people on Medicare who are diagnosed obese or overweight, about 3.6 million also have cardiovascular disease, the analysis shows. This population makes up about 7% of those on Medicare.
The analysis also examined the potential costs of Medicare covering Wegovy for use in patients diagnosed with both obesity and cardiovascular disease.
Assuming 10% of eligible individuals use Wegovy in a year, Medicare would see an additional $2.8 billion in Part D spending in just one year for this drug alone. Part D are plans through private insurers that have contracts with the federal government.
Monthly out-of-pocket costs of for individuals taking Wegovy could run $325 to $430 if they have to pay a percentage of the drug’s $1,300 list price for a month’s supply, according to the analysis.
Although a new cap on Part D spending will reduce individuals' out-of-pocket costs to around $3,300 in 2024 and $2,000 in 2025, these are "still significant sums for those who live on modest incomes," KFF wrote in its report.
KFF used Medicare data from 2020 for its study.
