Health
3.6 million Medicare enrollees could be eligible for Wegovy coverage
About 3.6 million Medicare enrollees may be eligible for coverage for the anti-obesity drug Wegovy, according to a KFF analysis released Wednesday. But it costs Medicare nearly $3 billion a year and could lead to higher Part D premiums for all beneficiaries. Medicare announced last month that Part D drug plans may begin offering Wegovy coverage for beneficiaries who are overweight or obese and have a history of heart disease. After the U.S. Food and Drug Administration approved drug company Novo Nordisk's application to add cardiovascular benefits to the drug's label, his GLP-like drug, Wigovy and its sister drug Ozempic, which is approved to treat diabetes. 1 The popularity of the drug has increased explosively. Weight loss. Medicare is prohibited by law from covering anti-obesity drugs, but more beneficiaries will be covered by the FDA's expanded approval of Wegovy to reduce the risk of heart attack and stroke in certain people The door was opened. An estimated 7% of Medicare enrollees (including those slightly above that number) were diagnosed as overweight or obese, according to KFF.His Wegovy coverage criteria for 2020 Compatible. Of the 3.6 million beneficiaries, 1.9 million had diabetes and may have already had Medicare coverage for GLP-1 drugs for that disease. How many beneficiaries will start taking Wegovy will depend on several factors, including how much insurance companies add to their plans. Part D Official Collection. CVS Health's Aetna and several other insurers have said they intend to do so, although they may add restrictions such as prior authorizations. Wegovy's high fees may also be a hurdle for some subscribers, who may face coinsurance costs of $325 to $430 per month. before reaching a new cap on drug copays, according to KFF. Based on brand-name drugs alone, the cap would be about $3,300 this year and $2,000 next year. Only 10% of eligible beneficiaries will use Wegovy, and Part D plans will receive a 50% rebate on the monthly list price of $1,300, according to KFF. But while the exact impact is difficult to pinpoint, enrollees will likely pay higher Part D premiums, said Juliette Cubansky, deputy director of the Medicare program. KFF.Medicare policy faces sharp increase in spending on GLP-1 drugs. The company spent $5.7 billion on Ozempic and other similar diabetes drugs in 2022, up from $57 million in 2018, according to a separate KFF analysis, but that estimate doesn't include rebates. Medicare could select Wigoby and Ozempic for drug negotiation program as early as 2025, KFF said, as spending on drugs could decline as early as 2025.
About 3.6 million Medicare enrollees could be eligible for coverage for the anti-obesity drug Wegoby, according to a report. KFF analysis It was released on Wednesday. However, this would cost Medicare nearly $3 billion a year and could lead to higher Part D premiums for all beneficiaries.
Medicare last month allowed Part D drug plans to include those who are overweight or obese and have a history of heart disease, after the U.S. Food and Drug Administration approved drug company Novo Nordisk's application to add cardiovascular claims to drug labels. The company announced that it may start applying WeGoBe to certain beneficiaries.
GLP-1 drugs, such as Wegovy and its sister drug Ozempic, which is approved to treat diabetes, have exploded in popularity because they lead to weight loss. Medicare is prohibited by law from covering anti-obesity drugs, but more beneficiaries will be covered by the FDA's expanded approval of Wegovy to reduce the risk of heart attacks and strokes in certain people The door was opened.
According to KFF, an estimated 7% of Medicare enrollees met Wegovy eligibility criteria in 2020, including just over a quarter of those diagnosed with overweight or obesity. Of the 3.6 million beneficiaries, 1.9 million had diabetes and may have already been eligible for Medicare coverage of GLP-1 drugs for the disease.
How many beneficiaries start using Wegovy will depend on several factors, including the number of insurance companies that add Wegovy to their Part D formula. CVS Health's Aetna and several other insurers have said they intend to do so, although they may impose restrictions such as pre-authorization requirements.
Wegovy's high price tag may also be a hurdle for some enrollees, who could face coinsurance costs of $325 to $430 per month before reaching new drug out-of-pocket limits. KFF said there is. Based on brand-name drugs alone, the cap would be about $3,300 this year and $2,000 next year.
According to KFF, assuming only 10% of eligible beneficiaries use Wegovy and Part D plans receive a 50% rebate on the list price of $1,300 per month, the price of Medicare will approach $3 billion in one year. It is said that there is a possibility.
But while the exact impact is difficult to pinpoint, enrollees will likely pay higher Part D premiums, said Juliet Cubansky, associate director of KFF's Medicare policy program.
Medicare faces a sharp increase in spending on GLP-1 drugs. A separate KFF analysis shows the company will spend $5.7 billion on Ozempic and other similar diabetes drugs in 2022, up from $57 million in 2018, but that estimate does not include rebates.
According to KFF, Medicare could select Wigoby and Ozempic for its drug negotiation program as early as 2025, which could reduce spending on drugs.
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