By Dennis Thompson HealthDay Reporter<\/b><\/p>\n
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WEDNESDAY, April 24, 2024 (HealthDay News) — A budget-busting 3.6 million Medicare recipients could now be eligible for coverage of the weight-loss drug Wegovy, a new KFF analysis says.<\/p>\n
That s because the U.S. Food and Drug Administration has approved the use of Wegovy (semaglutide) to reduce the risk of heart attacks<\/a> and stroke<\/a> in certain patients, the study says.<\/p>\n The FDA s ruling potentially allows Wegovy prescription coverage for more than a quarter of 13.7 million Medicare patients who ve been diagnosed with obesity or excess weight, KFF says.<\/p>\n Those 3.6 million people — about 7% of all beneficiaries — have established heart disease as well as excess weight, and thus could be eligible for coverage of Wegovy.<\/p>\n However, KFF notes that among this group, 1.9 million also have diabetes and therefore are already eligible for coverage of weight-loss drugs like Wegovy<\/a> or Zepbound<\/a>.<\/p>\n Although Wegovy already had FDA approval as an anti-obesity medication, Medicare is prohibited by law from covering drugs when prescribed for obesity, KFF said in a news release.<\/p>\n How the FDA s change affects Medicare spending will depend in part on how many Part D plans add coverage for Wegovy, and the extent to which plans will restrict coverage, researchers said.<\/p>\n Assuming just 10% of eligible Medicare patients use Wegovy in a given year, and assuming a 50% rebate on the list price, the program would still incur nearly $3 billion in additional prescription spending each year for the one drug alone, researchers said.<\/p>\n Further, beneficiaries who take Wegovy could face monthly out-of-pocket costs of $325 to $430 if they have to pay a percentage of the drug s $1,300 list price for a month s supply.<\/p>\n New Part D caps on out-of-pocket spending would limit beneficiaries costs to $3,300 in 2024 and $2,000 in 2025, but KFF noted those are significant bites for people living on modest fixed incomes.<\/p>\n It s possible Medicare could select semaglutide for drug price negotiation as early as 2025, given that the drug was first approved by the FDA in late 2017 for treatment of type 2 diabetes<\/a>, KFF says.<\/p>\n If that happens, a lower negotiated price could be available as early as 2027, helping to lower Medicare spending on the drug.<\/p>\n More information<\/strong><\/p>\n UCLA has more on semaglutide for weight loss<\/a>.<\/p>\n SOURCE: KFF, news release, April 24, 2024<\/p>\n <\/i><\/p>\n