Medicare to Cover Wegovy for Patients With Serious Heart Risks

The cost of Wegovy will soon be covered by Medicare, according to an announcement from the federal health insurance program for seniors on Thursday. And while that’s great news for people over 65 who want access to a medication that’s drawn so much attention for its ability to help with weight loss, there’s just one catch. Medicare will only pay if patients have potentially serious heart problems.

Wegovy is the brand name of Novo Nordisk’s anti-obesity medication semaglutide, first approved in the U.S. in 2021. And along with Ozempic, which is also made by Novo Nordisk, the drugs have become hot-ticket items for people looking to lose weight. But the cost of Wegovy, which can be over $1,300 a month, has been prohibitively expensive for many Americans.

Wegovy was found to reduce heart attacks and strokes in a major trial last summer, paving the way for the FDA to approve doctors being able to prescribe the medication for that purpose earlier this month.

A spokesperson with Novo Nordisk, which is based in Denmark, told Gizmodo on Thursday the company is encouraged by the new guidance from the Centers for Medicare and Medicaid Services, but stressed that obesity alone was an issue that should get proper consideration when the government is offering this kind of financial help.

“Wegovy is the only weight management medicine that is also approved to reduce the risk of major adverse cardiovascular events in patients with established cardiovascular disease and either obesity or overweight. But there’s more work to be done because Part D coverage is still not available for obesity medicines when used for chronic weight management,” the Novo Nordisk person wrote.

The Inflation Reduction Act, passed in 2022, included a number of new provisions to help those on Medicare, including a new cap on prescription drug costs of $3,000 that takes effect this year. That change will help about 1 million seniors who pay for incredibly costly drugs commonly used in cancer patients.

But even with positive changes like the Inflation Reduction Act, the cost of drugs in the U.S. is still astronomically high compared to other countries. And these kinds of improvements help those on Medicare, the cost is borne by the taxpayer rather than through a negotiation of lower prices often achieved in peer countries. Medicare was banned from negotiating prices on most drugs in 2003, a disastrous law that’s now being slowly rolled back by legislation championed by Democrats and President Joe Biden.

The Associated Press points out there’s serious debate about whether Medicare should cover anti-obesity drugs like Wegovy, often because it’s not clear whether the high prices paid by the government will be offset by decreases in costs for treating obesity.

“We will continue to advocate for policies that enable access to obesity medicines for the many patients who don’t yet have coverage,” Novo Nordisk told Gizmodo. “Collaboration across the healthcare system is key to educate and to broaden coverage of obesity medicines.”

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