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 who are both obese and have cardiovascular disease, could cost the system up to $145B per year.

If all beneficiaries who are eligible for Wegovy were to receive it, it would cost Medicare $34B to $145B annually, depending on the definition of established CVD, according to a report in the Annals of Internal Medicine.

In March, the U.S. FDA approved an additional indication for Wegovy for reduction of major CV events such as heart attack, stroke and death in overweight or obese people with established CVD. This indication made the drug eligible for Medicare coverage for those with heart-related ailments.

The $34B figure is based on 3.6M enrollees becoming eligible for Wegovy coverage, while $145B is if 15.2M are eligible, based on a more liberal definition of CVD.

A Kaiser Family Foundation study released in April found that 3.6M Medicare patients could qualify for Wegovy coverage.

Eli Lilly’s (LLY) rival Zepbound (tirzepatide) does not yet have a CVD indication though the company is pursuing it. Data from the phase 3 SUMMIT trial released earlier in August found the drug cut the risk of heart failure by 38% compared to placebo.