Benefits Bulletin: Medicare to Cover Wegovy for Most Senior Citizens

Benefits Bulletin: Medicare to Cover Wegovy for Most Senior Citizens

Edward Cates, Chairman of the Board, TSCL

The self-administered weight loss medication Wegovy came on the market in June 2021 with incredible promise. Clinical trials have shown that, on average, people who take it lose up to 15 percent of their body weight. That’s a remarkable result, but unfortunately for seniors, it costs more than $1,000 per month out-of-pocket and hasn’t been covered by Medicare Part D.

Until now, that is. This March, the Centers for Medicare and Medicaid Services (CMS) issued new guidance that directs Medicare to begin covering Wegovy.

There’s a catch, of course: It will only be covered to reduce the risk of heart attacks or strokes, not for weight loss. However, that shouldn’t pose a challenge to getting a prescription for most seniors who struggle with obesity. After all, obesity is a major risk factor for heart disease.

Making Wegovy available should extend the lives of millions of seniors. Nearly 42 percent of people in the U.S. aged 61 or older were obese in 2020, and heart disease is the leading cause of death among people aged 65 and older, according to the Centers for Disease Control and Prevention (CDC). What’s more, virtually all projections expect obesity to become more prevalent in the future, so the impact of making Wegovy available should only grow with time.

The potential drawback of making Wegovy available is that its high price may drive up the cost of Medicare Part D plans. However, the Federal government will likely try to address this issue by selecting it for price negotiation, according to the Congressional Budget Office. This would lower the price of Wegovy for seniors, as well as the price of any other anti-obesity medications approved for Medicare Part D in the future.

TSCL feels that, if anything, this proves that the Federal government should extend its ability to negotiate drug prices for Medicare. Under the Inflation Reduction Act, Medicare can only negotiate the prices of 10 drugs for 2026, 15 drugs for 2027 and 2028, and 20 drugs for 2029 and beyond.

You can be confident that we will be working hard to advocate for legislation that makes more life-changing drugs available to seniors and allows the government to negotiate affordable prices for them in the future.