More than 3 million individuals with Medicare might be qualified for protection of Wegovy now that the smash hit weight reduction drug is likewise authorized in the U.S. for heart health, according to an analysis launched Wednesday by health policy research study company KFF.
But some qualified recipients might still deal with out-of-pocket expenses for the extremely popular and pricey drug, KFF stated. Certain Medicare prescription drug strategies might likewise wait up until 2025 to cover Wegovy.
Medicare’s budget plan might be strained as more strategies cover the expenses ofWegovy The program’s prescription drug strategies might invest an extra net $2.8 billion if simply 10% of the qualified population, an approximated 360,000 individuals, utilize the drug for a complete year, according to KFF.
Under brand-new assistance released in March, Medicare Part D strategies can cover Wegovy for clients as long as they are overweight or obese, have a history of heart problem and are particularly recommended the weekly injection to decrease their danger of cardiovascular disease and strokes. The Food and Drug Administration authorized Wegovy for that function in March.
KFF stated that uses to 3.6 million, or 7%, of overall recipients, based upon 2020 information. That group likewise comprises 1 in 4 of the 13.7 million Medicare clients who are overweight or obese. Those numbers might be greater based upon more current information, the not-for-profit group stated.
The analysis recommends that, for the very first time, particular Medicare recipients will have the ability to gain access to Novo Nordisk‘s Wegovy without needing to carry the overall $1,300 month-to-month price alone.
Notably, Medicare prescription drug strategies administered by personal insurance companies, called Part D, presently can not cover Wegovy and other GLP-1 drugs for weight reduction alone. GLP-1s are a buzzy class of weight problems and diabetes treatments that work by simulating a hormonal agent produced in the gut to reduce an individual’s cravings and control their blood glucose.
But KFF’s analysis discovered that Medicare recipients who take Wegovy might still deal with month-to-month out-of-pocket expenses of $325 to $430 if they need to pay a portion of the drug’s sticker price for a month’s supply.
A brand-new Part D cap on out-of-pocket costs would restrict recipients’ out-of-pocket expenses to around $3,300 in 2024 and $2,000 in2025 Still, those amounts are a substantial problem for those who reside on modest earnings.
Some clients likewise might have a hard time to gain access to Wegovy if Part D prepares that choose to cover it execute particular requirements to manage expenses and guarantee the drug is being utilized properly. That might consist of “step therapy,” which needs strategy members to attempt other lower-cost medications or ways of reducing weight before utilizing a GLP-1 such as Wegovy.
“These factors could have a dampening effect on use by Medicare beneficiaries, even among the target population,” KFF composed in its analysis.
Some Part D strategies have actually currently revealed that they will start covering Wegovy this year, however it’s uncertain how prevalent protection will be. KFF stated numerous strategies might hesitate to broaden protection now given that they can’t change their premiums mid-year to represent greater expenses connected with usage of the drug.
That suggests wider protection in 2025 might be most likely, KFF included.
Medicare currently covers GLP-1s and other treatments for diabetes, such as Novo Nordisk’s smash hitOzempic
Among the Medicare recipients who are overweight or obese and have a history of heart problem, 1.9 million likewise have diabetes, according to KFF. That makes them currently qualified for Medicare protection of other GLP-1 drugs authorized for that condition.
