Medicare coverage of Novo Nordisk’s Wegovy could cost up to $145B annually

Novo Nordisk’s (NVO) weight-loss drug Wegovy (semaglutide), which can be prescribed to Medicare beneficiaries with obesity and cardiovascular disease, could cost the system up to $145 billion a year.

If all eligible beneficiaries receive Wegovy If achieved, it would cost Medicare between $34 billion and $145 billion annually, depending on the definition of cardiovascular disease, according to a report in Annals of Internal Medicine.

In March, the FDA approved an additional use for Wegovy to reduce major cardiovascular events such as heart attacks, strokes, and death in overweight or obese people with cardiovascular disease. This use made the drug eligible for Medicare coverage for those with heart-related conditions.

The $34 billion figure is based on 3.6 million eligible members for Wegovy coverage, while the $145 billion figure is based on 15.2 million eligible members, based on a more liberal definition of cardiovascular disease.

A study by the Kaiser Family Foundation released in April found that 3.6 million Medicare patients may be eligible for Weigovy coverage.

Eli Lilly’s (LLY) competitor Zebound (tirzepatide) is still not available for treating cardiovascular disease, though the company is pursuing it. Data from the phase 3 SUMMIT trial released earlier in August showed the drug reduced the risk of heart failure by 38% compared with a placebo.