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:
- Fills of Wegovy increased 136% compared to the previous six months across all coverage sources—Medicare, Medicaid, private insurance and cash-pay—and grew significantly faster than other GLP-1s sharing the same active ingredient, semaglutide. The new cardiovascular indication drove an estimated 593,000 additional Wegovy prescriptions.
- Medicare fills of Wegovy increased 598%, far outpacing growth in other coverage sources. This increase signals pent-up demand among Medicare beneficiaries and shows how FDA approvals of GLP-1s for indications beyond obesity can expand access.
- However, six months after the Medicare announcement, less than 1% of the estimated 3.6 million beneficiaries thought to be eligible based on their weight and cardiovascular health had filled a Wegovy prescription. Several factors could explain the low uptake: Part D plans were likely hesitant to add the costly drugs to their formularies, patients could have faced barriers like high-cost sharing or other restrictions on use, and providers may have had limited awareness of the changes.
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.
