Wegovy Access for 3.6M Medicare Beneficiaries Amidst Coverage Limitations and Cost Considerations: Analysis by KFF After New Approval

A new analysis by health policy research organization KFF has revealed that over three million people with Medicare could potentially be covered for the weight loss drug Wegovy, following its recent approval in the US for heart health purposes. However, some eligible beneficiaries may still face out-of-pocket costs due to certain requirements imposed by private insurance providers administering Part D plans under Medicare’s prescription drug programme. According to KFF, which conducted a review of data from 2020 (and stated that this figure might be higher now), the total beneficiaries who meet eligibility criteria for coverage come to roughly 36% million or 7%.
These findings arrive against the backdrop of new guidance issued by Medicare in March, which permits Part D plans to cover Wegovy as long as patients are obese or overweight and have a history of heart disease. The drug has been approved for reducing risks associated with cardiovascular events such as stroke or heart attacks through GLP-1 mimicking processes that decrease hunger and manage blood sugar levels in the body.
KFF’s analysis suggests this could be the first time some Medicare beneficiaries will have access to Wegovy without having to bear its entire $1,300 monthly price tag alone. However, it also revealed that these patients may still face out-of-pocket costs of around $325-$430 per month if they are required to pay a percentage of the drug’s list price for one supply. A new Part D cap on spending is expected to limit beneficiaries’ annual maximum charges starting from 2024 and progressing through further amendments by next year; but some observers remain uncertain regarding broader coverage until early-to mid-year plan redesign efforts become a reality, KFF says.
While it seems clear that these provisions might encourage better drug adherence levels in Wegovy beneficiaries subject to the new Part D cap on spending limits, there are still concerns about how widely this treatment will be covered by private insurance providers administering Medicare’s prescription drug programme (Part D). Some of them may require patients with GLP-1 drugs such as Wegovy to first try other lower cost medications or weight loss methods before being eligible for the former, KFF noted. These restrictions could dampen demand from target populations despite recent FDA approval and growing popularity among obese individuals seeking effective treatments that can help them lose significant amounts of bodyweight over time – an issue which is expected to affect millions across America in coming years as rates continue climbing at a rapid pace.