1 in 4 Medicare beneficiaries with obesity could get Wegovy despite coverage ban

An estimated 3.6 million Medicare beneficiaries could have access to Wegovy after the Food and Drug Administration (FDA) approved a drug that reduces the risk of accidents related to cardiovascular disease.

KFF’s analysis found that of the 13.7 million Medicare enrollees diagnosed with obesity, 3.6 million, or roughly 1 in 4, had a diagnosis of cardiovascular disease. These potential beneficiaries represent approximately 7 percent of all Medicare enrollees.

These findings are based on 2020 data.

Wegovy is a type of semaglutide that is also sold as the diabetes drug Ozempic. As a GLP-1 agonist, it is one of a class of drugs that until recently was only approved for the treatment of diabetes and obesity.

The Medicare Modernization Act of 2003 prohibits Medicare from covering weight loss drugs. Lawmakers, pharmaceutical companies, and obesity care experts are pushing for passage of the Obesity Treatment and Abatement Act (TROA) to change this. Obesity medications and other related services are also covered.

KFF’s analysis also predicted the potential costs of covering Wegovy. The policy nonprofit estimated that if just 10% used his Wegovy in a given year, Medicare would incur nearly $3 billion in additional Part D spending.

“As more Medicare beneficiaries become obese or overweight, the legal ban on Medicare coverage of anti-obesity drugs will be lifted if GLP-1 becomes available based on other approved uses for these drugs. “This could reduce the cost of the bill,” KFF’s analysis said. .

Beneficiaries may also incur potential out-of-pocket costs ranging from $325 to $430.

F.D.A. Approved by Wegovy Last month, a study was conducted that aimed to reduce the risk of cardiovascular death, heart attack, and stroke in patients with cardiovascular disease and obesity. The agency cited the results of a multinational study conducted by Novo Nordisk, the manufacturer of Wegovy, which found the drug reduced the risk of serious cardiovascular events by 20 percent.

The mechanism of action for this reduction was not established in the study.