New Medicare rules could make at least 3.6 million Americans eligible for treatment with the weight-loss drug Wegovy The rules extend coverage of Wegovy to people with high BMI and heart disease That drug coverage could cost $10 billion to $34 billion, depending on how narrowly heart disease is defined TUESDAY, Aug. 27, 2024 (HealthDay News) -- New Medicare rules could make 3.
6 million Americans -- or even more -- eligible for treatment with the pricey weight-loss drug , a new study finds. Under the new rules, the government will pay for Wegovy treatment if a person with high BMI also has heart disease. Until now, federal regulations have restricted Medicare from covering drugs prescribed solely for weight loss, researchers noted.
For this study, researchers analyzed data from people 65 and older who took part in a federal health and nutrition survey between 2011 and 2020. Maximum annual costs to Medicare could be as high as $34 billion if Wegovy is prescribed to all patients with high BMI and a history of heart attack, stroke, hardened arteries or chest pain, the data show. Wegovy has a list price of about $1,350 for a 28-day supply, according to .
But even if heart disease is more narrowly defined by federal regulators, covering Wegovy (semaglutide) looks to be a budget-buster for the Medicare program, researchers said. Under a narrow definition of heart disease, “only 1 in 7 Medicare beneficiaries with elevated BMI are likely to be eligible to receive semaglutide, but co.