Medicare to Cover Wegovy for Patients with Heart Disease

Good news! According to an agency spokesperson, Medicare will provide coverage for Wegovy for patients who have an increased risk of heart attack, stroke, or other serious cardiovascular problems. Experts say that the decision could grant millions of Medicare recipients access to the somewhat pricey weight loss medication. Here’s what you need to know about Wegovy and Medicare’s coverage of it.

What Is Wegovy?

Wegovy is a brand name for a once-weekly injectable prescription medication called semaglutide. It’s often used for chronic weight management in obese adults who have at least one weight-related condition, such as high blood pressure, type 2 diabetes, or high cholesterol. Wegovy belongs to a class of medications known as glucagon-like peptide-1 (GLP-1) receptor agonists. The U.S. Food and Drug Administration approved Wegovy for the treatment of obesity in June of 2021. However, Medicare will NOT cover Wegovy if it is only used for weight management, according to the spokesperson.

How Can Wegovy Help Someone with a Heart Condition?

Wegovy can reduce the risk of heart attacks and strokes by as much as 20%. Obesity is a significant risk factor for various heart conditions, including coronary artery disease, heart failure, and atrial fibrillation. By promoting weight loss, Wegovy may help reduce the strain on the heart and improve cardiovascular health. Losing weight can lead to improvements in blood pressure, cholesterol levels, and blood sugar control, all of which are important for heart health.

Semaglutide, the active ingredient in Wegovy, has beneficial effects on several cardiovascular risk factors. “This is amazing evidence that semaglutide not only helps people with diabetes prevent devastating complications but also helps patients with obesity lose weight and avoid major adverse heart consequences,” said Dr. Susan Spratt, the senior medical director for the Population Health Management Office at Duke Health in North Carolina.

What Are the Side Effects of Wegovy?

Unfortunately, as with any medication, Wegovy may have side effects. Nausea is one of the most common side effects reported by individuals taking Wegovy. It may occur particularly when starting treatment or after increasing the dosage. Eating smaller, more frequent meals or taking the medication with food may help reduce nausea. Other common side effects may include diarrhea, constipation, vomiting, and abdominal pain. Other rare, but more serious side effects, observed in animal studies, included an increased risk for thyroid cancer, pancreatitis, low blood sugar, and gallstones.

How Can a Medicare Patient Get Wegovy?

In order to get Wegovy, a patient must have Medicare Part D, which helps cover the cost of prescription drugs. There are several ways to get Medicare drug coverage.

Choosing a Medicare Part D plan using Medicare.gov‘s online tools can be a helpful and efficient way to find the right coverage for your prescription drug needs.

Start by gathering your information.

• Make a list of your current prescription drugs, including dosages and frequencies.
• Note any preferred pharmacies or providers you would like to use.
• Consider your budget and desired level of coverage.

Visit the Medicare Plan Finder on Medicare.gov.

• Go to www.medicare.gov.
• In the navigation, scroll over “Health & Drug Plans.”
• Click “Drug Coverage (Part D)

• Enter your ZIP code and follow the prompts to provide additional personal information.

Enter your prescription drugs.

• On the Medicare Plan Finder, select the option to enter your medications.
• Type in the names of your prescription drugs and follow the prompts to provide details such as dosages and frequencies.
• If you’re unsure about a specific medication, you can skip it or consult with your healthcare provider for accurate information.

Compare available plans.

• After entering your medications, the Medicare Plan Finder will generate a list of available Part D plans in your area.
• Use the filtering options to narrow down the results based on factors like premium costs, deductible amounts, and copayments.
• Pay attention to the estimated annual costs and the coverage details provided for each plan.

Review the plan details and make your selection.

• Click on individual plan options to review the specific details, benefits, and restrictions.
• Consider factors such as formulary coverage (ensuring your medications are covered), preferred pharmacies, and any utilization management requirements.
• Compare the total estimated annual costs, including premiums, deductibles, copayments, and coinsurance, to find a plan that aligns with your budget and coverage needs.

More Medicare Resources

Remember—you cannot get Wegovy if you only plan to use it as a weight loss drug. “We could see Medicare patients with both conditions get coverage of this drug for its heart health benefits,” said Juliette Cubanski, deputy director of the Medicare policy program at KFF. “That’s potentially a big deal given the large demand for this drug even in the absence of many insurers covering it.” However, if you have Medicare Part D and a heart issue, you may want to ask your doctor more about Wegovy. It might help you live your best, healthiest life!

Looking for even more great Medicare resources? Then check out these articles before you go!

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• The Easiest Explanation You’ll Ever Hear About Medicare and How to Enroll
• 3 Shocking Things Medicare Does Not Cover
• Should I Get a Medicare Supplement or Advantage Plan?