United States: New Medicare rules could make up to 3.6 million Americans eligible for the weight-loss drug Wegovy. Medicare will now cover Wegovy if a person with a high BMI also has heart disease. Previously, Medicare did not cover drugs prescribed only for weight loss.
How Research Informed the Change
As reported by Health Day, Researchers found this out by analyzing data from people aged 65 and older who participated in a federal health and nutrition survey from 2011 to 2020.
And here the maximum annual costs to the Medicare could be as high as 34 billion USD and if the Wegovy is prescribed to all the patients with the high BLI and also a history of heart attack, stroke,hardened arteries or chest pain that’s what the data shows.
Projected Annual Costs
Also Wegovy has a list of the price about 1,350 USD for almost 28 day supply according to the GoodRx.com.
But even if the heart disease is more narrowly defined by the federal regulators covering Wegovy which looks like to be a budget buster for the Medicare program said the researchers.
Narrow Definition of Heart Disease
Under a narrow definition of the heart disease only 1 in the 7 Medicare beneficiaries with the elevated BMI is likely to be eligible to receive semaglutide but the costs to Medicare could still exceed almost around 10billion USD as per year said the lead researcher Dr. Alexander Chaitoff with the Brigham and the Women’s Hospital Center for the Healthcare Delivery Sciences.
Potential Budget Strain
“In this conservative coverage scenario, that means most beneficiaries with elevated BMI and cardiovascular risk would remain ineligible for semaglutide, yet the medication could still potentially become one of the costliest drugs to Medicare,” Chaitoff said in a hospital news release.