Medicare premiums may rise as plans move to cover Wegovy

Wegovy was approved in March to reduce the risk of heart attack and stroke in adults with heart disease, paving the way for Medicare coverage of weight loss drugs. Now, healthcare policy experts anticipate monthly premiums for millions of Medicare enrollees could increase by 2026, though the amount by which prices may jump remains to be seen. 

"I worry greatly, both in terms of higher premiums and also Medicare funds over the next decade," Lawrence Gostin, director of the O'Neill Institute for National and Global Health Law at Georgetown University in Washington, D.C., told NBC News in an April 2 report. "The drug needs to be taken lifelong to be effective, so we're looking at potentially enormous lifelong costs." 

Per guidance recently issued by CMS, Medicare Part D drug benefit plans may cover anti-obesity medications if they are approved for additional health benefits and used for those conditions. The agency said it notified health plans on March 20 regarding the new guidance, which states that Wegovy can be covered for patients with heart disease who are either overweight or obese. It will not be covered if it's solely being used for weight loss. 

Experts told the news outlet it's not yet clear how many of the 65 million Americans on Medicare meet those criteria, but that it's likely several million people.

"If costs go up, then the contribution from the federal government goes up, and generally speaking, premiums also go up," Juliette Cubanski, PhD, deputy director of the Medicare policy program at KFF, told NBC

In 2023, more than 50 million Medicare beneficiaries were on Part D plans. This year, the average monthly premium for those plans was $55.50, per CMS. Private insurance companies that administer Part D plans have already started to lock in rates for the 2025 enrollment year, so any price increase likely wouldn't happen within the next year, according to experts. 

Many Part D plans already cover glucagon-like peptide-1 agonists such as Ozempic and Mounjaro for Type 2 diabetes. In 2022, gross Medicare spending on GLP-1 drugs hit $5.7 billion. Zooming in on Ozempic, which Medicare began covering in 2018, spending skyrocketed from $2.6 billion in 2021 to $4.6 billion in 2022. 

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