Medicare has announced its plan to cover Wegovy, a high-cost weight-loss drug, for individuals with elevated heart disease risk. This marks a notable advancement that potentially welcomes millions of patients to this potentially transformative treatment.
The decision has followed the recent extension of the FDA’s approval for Wegovy usage. This drug aims to lessen cardiovascular disease risks in overweight or obese individuals, presenting a vital milestone for those struggling with weight and heart health issues.
However, it should be stated that Medicare won’t finance Wegovy if it is solely utilized for weight management. The Medicaid program is now obligated to encompass Wegovy in their coverage, specifically taking heart disease risk reduction into consideration.
Concerns have been voiced regarding this coverage decision. Lawrence Gostin from Georgetown University cautions that this might jeopardize Medicare’s financial stability owing to Wegovy’s high price, potentially inflating the program’s budget. The move could also create a model for coverage of other expensive treatments, possibly exacerbating the system’s stress.
Medicare announces coverage for Wegovy
Additionally, there could be potential implications for Medicare’s enrollees, including higher premiums or service cutbacks. Consequently, the feasibility of this decision and its impacts need meticulous examination by policymakers.
Despite these concerns, it is highlighted that a large proportion of heart disease sufferers are obese or overweight. Juliette Cubanski, deputy director of a Medicare policy program, noted that many Medicare patients might still be eligible for Wegovy coverage due to its potential cardiac health benefits, even if the drug is not covered for weight loss alone. This emphasizes that Wegovy’s significance extends beyond weight loss, as it might also positively impact heart health. Consequently, patients dealing with obesity could potentially find this a significant aid in managing both weight and heart health.
Medicare will cover Wegovy under Medicare Part D, which regulates drugs prescribed for home use. As of now, the response from private insurance providers offering supplemental Part D coverage is unclear, with the high cost of Wegovy possibly being a deterrence.
