Medicare Gets Big Change

Medicare recipients can now access the weight-loss drug Wegovy through their insurance plan even if they don't have diabetes.

Previously, weight-loss drugs, such as Wegovy and Ozempic, were barred from Medicare coverage unless the beneficiary had diabetes and needed help to improve their blood-sugar levels.

Now, Wegovy has been approved for coverage for patients on Medicare who have a history of heart disease, The Wall Street Journal reported. Earlier in March, the Food and Drug Administration approved Wegovy for use in reducing the risk of heart attacks and strokes. The drug was found to reduce cardiovascular risk by about 20 percent.

Doctors can now prescribe the drug to seniors struggling with their weight who also have a history of heart disease or stroke. The same is true for those receiving Medicare who have a disability.

The update is the first step in what proponents of weight-loss drugs like Wegovy and Ozempic hope can be a mass approval of anti-obesity medications for conditions beyond diabetes.

Because obesity is linked to a range of health issues, including heart disease and cancer, weight-loss drugs could be prescribed and approved for millions of Americans. Currently, paying for these types of drugs without insurance can be costly, with a monthly supply of Wegovy listed at more than $1,300.

Now that Medicare has begun to approve weight-loss drugs for conditions beyond diabetes, many hope commercial health insurance companies will also offer coverage.

However, there may be significant financial ramifications to the approval of Wegovy for Medicare recipients with heart disease.

According to The New England Journal of Medicine, about 10 million Medicare beneficiaries are obese. Even if just one in 10 of those Medicare recipients began taking Wegovy, Part D Medicare spending could surge by $26.8 billion, or almost 20 percent, of yearly payments. If that happens, premiums are likely to skyrocket for those on Part D plans.

Despite these financial repercussions, Barb Herrera, who runs the website HealthAtAnyCost.com, said the new approval of Wegovy for heart disease would ultimately save lives.

"It's thrilling to see Medicare paying for Wegovy for those with a variety of heart issues because it will certainly save many lives," Herrera told Newsweek. "It's clear these medications are going to serve many more than just those with diabetes or who have obesity."

Herrera, who lost 200 pounds over the course of two years, said the only thing she worried about was availability. She said she struggled to find Mounjaro, and that many others reported difficulties finding any kind of semaglutide or tirzepatide medications.

"As the market gets more crowded, how will we all be able to find the medications?" Herrera added.

Sue Decotiis, a weight-loss doctor in New York, echoed Herrera's concern about Wegovy's availability, as there is already a shortage of the drug. A shortage that could cause hurdles for new patients.

"If Wegovy is going to be covered for heart disease, there's going to be a lot of background checking," Decotiis told Newsweek. "There are so many drugs out there to treat heart failure, they may have to prove that other drugs didn't work for this patient first. They won't prescribe this first for treatment."

Doctors may also need to provide a lot of pre-authorization, she added.

"Heart failure doesn't go away," Decotiis said. "This could be a lifelong prescription. When you have someone on medication for a problem like this, what do they do if they can't get their hands on the drug because of the shortages? That could be really dangerous if they're relying on it."

Under Medicare, Ozempic and Mounjaro, which use the same ingredients as Wegovy, are approved for treating only Type 2 diabetes. So Medicare beneficiaries with heart disease would still be unable to access them.