Nearly 4 million Medicare patients with heart disease may be eligible for Wegovy coverage

Nearly 4 million Medicare patients could be eligible to have Wegovy covered after the FDA approved it to reduce risk of heart attack and strokes, KFF reported April 24.

The FDA approved the drug to reduce the risk of heart attack and strokes in people with cardiovascular disease who are overweight or obese. Currently, Medicare is prohibited by law from covering Wegovy and other medications when used specifically for obesity.

A KFF analysis of Medicare data from 2020 estimated that 3.6 million — or 7% of — beneficiaries had established cardiovascular disease and were obese or overweight. These people represent 26% of Medicare beneficiaries diagnosed as being overweight or obese. Of the 3.6 million, 1.9 million also had diabetes and may already be eligible for Medicare coverage of GLP-1s.

Some Part D plans have already announced that they will begin covering Wegovy this year, though it is not clear how widespread the coverage will be.

Based on the current list price of $1,300 per month, Medicare beneficiaries may be required to pay $325 to $430 per month before they would reach the new cap on annual out-of-pocket drug spending.

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