Novo Nordisk’s Wegovy, a new weight loss drug, recently received approval in the U.S. for its benefits in promoting heart health. This approval is expected to have a significant impact on more than 3 million people with Medicare, who could be eligible for coverage of Wegovy under their insurance plans.
While Medicare Part D plans can now cover Wegovy for obese or overweight patients with a history of heart disease, eligible beneficiaries may still face out-of-pocket costs for the expensive drug. This raises concerns about the potential strain on Medicare’s budget as plans cover the costs of Wegovy.
However, certain Medicare beneficiaries will be able to access Wegovy without shouldering the full monthly price tag, thanks to new Part D caps on out-of-pocket spending. Despite this, some beneficiaries taking Wegovy may still face monthly out-of-pocket costs.
To control costs and ensure appropriate use of Wegovy, some Part D plans may implement requirements for coverage. It is expected that coverage of Wegovy by Part D plans will become more widespread by 2025.
It is worth noting that Medicare already covers other diabetes treatments, such as Novo Nordisk’s Ozempic, indicating a pathway for the potential inclusion of Wegovy in the plan’s coverage options.
Overall, the approval of Wegovy for heart health is a significant development for Medicare beneficiaries, but the potential impact on out-of-pocket costs and Medicare’s budget remains a concern in the coming years.
