Millions of Americans could now be eligible for Medicare to cover their prescriptions of the popular weight loss drug Wegovy, according to a new analysis by KFF. The highly coveted medication belongs to the same class of drug as diabetes medication Ozempic, which is also known for its weight loss side effects.
The Food and Drug Administration expanded the approved use of Wegovy in March to include reducing heart risks for adults who are obese or overweight. The announcement came months after its maker Novo Nordisk announced results from a clinical trial that found the drug cut the risk of serious heart events by 20%.
While current law prohibits Medicare from covering weight loss drugs, the Centers for Medicare and Medicaid Services issued new guidance last month allowing Medicare plans to cover the drugs if they have been approved for an additional use that is already covered by Medicare. That means Medicare Part D plans can now offer coverage for Wegovy, specifically for the use of reducing heart risks. And that opens the door for about 1 in 4 Medicare beneficiaries that are obese or overweight to get coverage, according to KFF.
KFF, the nonprofit formerly called the Kaiser Family Foundation, analyzed Medicare data from 2020 and found that 7% of Medicare beneficiaries, or 3.6 million peolple, had an established cardiovascular disease and were obese or overweight.
Eli Lilly’s Zepbound could be next
Eli Lilly’s Zepbound, a Wegovy competitor, could be next in line to get Medicare coverage. Eli Lilly announced this month that the drug behind Zepbound was found to help alleviate sleep apnea in patients with obesity in late-stage clinical trials.
And the pharma giant said Wednesday that it’s planning to seek approval from the FDA to expand the use of the drug to include treating sleep apnea.