A new study from the University of Southern California’s Schaefer Center for Health Policy and Economics finds that Medicare prescriptions for Wegobee have skyrocketed since the program began covering the anti-obesity drug to prevent heart disease, but only for a fraction of beneficiaries who would be eligible for the treatment.
Medicare covers GLP-1 for type 2 diabetes, but is prohibited from paying for obesity drugs. However, in March 2024, Medicare clarified that health plans administering Part D benefits may cover Wegovy to reduce the risk of heart complications for beneficiaries with obesity or heart disease, after the U.S. Food and Drug Administration (FDA) expanded Wegovy’s approval for that purpose.
In the six months following this increased access, researchers found:
- Wegovy’s fills grew 136% across all insurance sources, including Medicare, Medicaid, private insurance, and cash payments, compared to the previous six months, significantly faster than other GLP-1s that share the same active ingredient semaglutide. New cardiovascular disease indications led to an estimated 593,000 additional Wegovy prescriptions.
- Wegovy’s Medicare caseload increased by 598%, far outpacing the growth of other coverage sources. This increase indicates pent-up demand among Medicare beneficiaries and shows how FDA approval of GLP-1 for indications other than obesity could expand access.
- But six months after Medicare’s announcement, less than 1% of the estimated 3.6 million beneficiaries who would be eligible based on their weight and cardiovascular health had filled their Wegovy prescriptions. Several factors may explain the low uptake rate. Part D plans were likely hesitant to add expensive drugs to their formularies, patients may have faced barriers such as high cost burdens or other usage restrictions, and health care providers may have had limited awareness of the change.
Medicare is currently aiming to broadly expand access to GLP-1 for weight loss through a temporary pilot program known as the Medicare GLP-1 Bridge that began this month. But the pilot, largely funded by the federal government, is set to expire after 2027, and health insurers have balked at long-term programs that would shift costs onto themselves.
Regardless of the future of the Bridge program, Medicare will continue to allow coverage of weight loss drugs for other FDA-approved indications other than obesity. In addition to cardiovascular disease, Wegovy is also approved for the severe liver disease MASH, and other GLP-1s are also approved for conditions such as obstructive sleep apnea and chronic kidney disease. Researchers continue to study GLP-1, which was first approved for type 2 diabetes, in a variety of other diseases.
Our study shows that federal policy changes may help increase access to GLP-1 for heart disease, but there is still a long way to go before patients can access and purchase these medications as clinical indications continue to expand. ”
Christopher Scannell, first author, non-resident scholar at the Schaefer Institute at the University of Southern California, and senior fellow at the Mann School of Pharmacy and School of Pharmacy at the University of Southern California
sauce:
University of Southern California
Reference magazines:
Scannell, CMP, Others. (2026). Changes in semaglutide filling due to FDA and Medicare policy expansion. AJMC. DOI: 10.1016/S0140-6736(24)01548-4. https://www.ajmc.com/view/changes-in-semaglutide-fills-following-expanded-fda-and-medicare-policies
