STAT+: Despite new Wegovy coverage, Medicare patients may face high drug costs and other hurdles
Medicare confirmed this week that it will cover Novo Nordisk’s obesity drug Wegovy if prescribed to prevent heart problems, but policy experts said Medicare patients are still likely to encounter significant barriers getting access to the highly popular and expensive drug.
Medicare previously wasn’t reimbursing for Wegovy, since the federal payer is legally barred from covering weight loss drugs. But the Food and Drug Administration this month approved Wegovy for preventing heart problems in people with obesity and heart disease, leading many to suspect that Medicare would start covering the drug for this usage.
Makers of obesity drugs have been hoping that showing additional benefits beyond weight loss would induce more insurers to cover them. Medicare’s guidance, first reported Thursday, moves in that direction, but experts point out that the private insurers that administer Medicare’s prescription drug benefit — called Part D — can still choose to not include Wegovy on their formularies, especially if they think it would be too costly.
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