Medicare could soon start to pay for weight-loss treatment drug Wegovy, the Wall Street Journal reports, a treatment that has gained a considerable amount of popularity — not the least among celebrities.
Though Medicare could stand to vastly increase access for a wider proportion of people, not every Medicare member will qualify. Per the report, only those with a history of heart disease, and who plan to use the drug to prevent heart attacks and strokes, could have their Wegovy treatments covered by insurance. In other words, the drug won't be covered by insurance if it's being used solely for the purpose of weight loss.
Wegovy, pharmaceutical company Novo Nordisk's brand name for the drug semaglutide, was approved by the Food and Drug Administration in 2021. It assists in weight loss by reducing appetite with a hormone in the gut, and according to a recent study, it also decreases cardiovascular risk by around 20 percent.
Medicare is a federal health insurance program for people over 65, and younger people with disabilities in the US.
Until now, US law has prevented the program's Part D drug-benefit plans from paying for obesity treatments. Part D plan holders tend to be senior citizens, but the program is technically open to all who qualify for Medicare.
Many Part D plans already pay for drugs with the same main ingredient as Wegovy called semaglutide, including Ozempic and Mounjaro — but only for treating diabetes.
Commercial insurers have balked at the substantial costs of the drugs as well.
But given the latest news — which still pivots on a green light from the federal government — the pressure on those insurers could soon rise considerably.
Obesity drug treatments like Wegovy can range from $900 to $1,300 a month without insurance, which makes them unaffordable to many. Experts, however, are predicting prices will fall as competing obesity drug makers enter the market.
Now that Medicare will start covering Wegovy, the drug will open up to price negotiations under president Joe Biden's Inflation Reduction Act, according to Reuters. In other words, the price will be determined based on the active ingredient, not brand.
With help from insurers, the drug could help millions fight heart disease, and eventually weight loss as well, according to experts.
"We could see Medicare patients with both conditions get coverage of this drug for its heart health benefits," deputy director of the Medicare policy program Juliette Cubanski told NBC News. "That’s potentially a big deal given the large demand for this drug even in the absence of many insurers covering it."
More on obesity drugs: New Weight Loss Pill More Effective Than Ozempic, Tests Show
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