Medicare prescriptions for Wegovy increased sharply after the program started covering the anti-obesity medication to prevent heart problems, but just a fraction of beneficiaries likely eligible received the treatment, according to new research from the USC Schaeffer Center for Health Policy & Economics.
Medicare covers GLP-1s for Type 2 diabetes but is prohibited from paying for the drugs to treat obesity. However, in March 2024 Medicare clarified that health plans administering the Part D benefit could cover Wegovy to reduce the risk of heart complications in beneficiaries with obesity and heart disease after the U.S. Food and Drug Administration (FDA) expanded approval of Wegovy for that purpose.
In the six months following this increased access, the researchers found:
Medicare is now aiming to broadly expand access to GLP-1s for weight loss through a temporary pilot program, known as Medicare GLP-1 Bridge , launched this month. However, the pilot, largely funded by the federal government, is set to expire after 2027, and health insurers have balked at a longer-term program that would shift costs onto them.
Regardless of the Bridge program’s future, Medicare will continue to allow coverage of weight-loss drugs for other FDA-approved indications beyond obesity. In addition to cardiovascular disease, Wegovy has also been approved for the serious liver disease MASH, while other GLP-1s have been approved for conditions including obstructive sleep apnea and chronic kidney disease. Researchers continue to study GLP-1s, which were first approved for Type 2 diabetes, for a range of other conditions.
"Although our study shows that federal policy change can help increase access to GLP-1s for heart disease, we still have a long way to go to ensure that patients can access and afford these medications as their clinical indications keep expanding," said first author Christopher Scannell , a nonresident scholar at the USC Schaeffer Institute and senior research associate at the USC Mann School of Pharmacy and Pharmaceutical Sciences.
About the study
The study was published July 9 in the American Journal of Managed Care . Other authors are John Romley, Rebecca Myerson, Dana Goldman and Dima Mazen Qato.