From CNBC: 2024-04-24 05:00:01

Medicare could cover Wegovy for 3 million beneficiaries, but out-of-pocket costs might still be a hurdle, according to KFF. Prescription drug plans may spend an extra $2.8 billion with just 10% usage. Guidelines now allow Part D plans to cover Wegovy for obese patients with heart disease risks, potentially benefiting 3.6 million beneficiaries.

This is the first time Medicare beneficiaries might access Wegovy without paying the full $1,300 monthly price tag. However, certain drug plans can still require out-of-pocket costs ranging from $325 to $430. A new cap on out-of-pocket spending in 2024 and 2025 could alleviate some of the burden for those with modest incomes.

Despite potential coverage by some Part D plans this year, widespread coverage might not happen until 2025 due to reluctance from plans to deal with immediate cost adjustments. Patients could face difficulties in accessing Wegovy if plans implement cost-controlling requirements like step therapy. Medicare beneficiaries are among the target population for this drug.

Medicare already covers other GLP-1 drugs like Ozempic for diabetes treatment. 1.9 million beneficiaries eligible for Wegovy also have diabetes. Plans may be more likely to expand coverage in 2025 instead of this year due to the inability to adjust premiums for immediate cost changes related to the drug.



Read more at CNBC: 3.6 million Medicare patients could get heart health coverage