Medicare covered Wegovy for CV risk; few eligible patients got it

Clinical takeaway: Medicare covers Wegovy for patients with overweight or obesity and established cardiovascular disease, with a temporary pilot now extending coverage to weight loss. Still, check your patient's plan formulary and cost sharing before prescribing.

When FDA approved Wegovy for cardiovascular risk reduction in March 2024, Medicare Part D beneficiaries gained a coverage pathway to an effective weight-loss drug. New data show the response was swift. Fills of Wegovy (semaglutide) through Part D rose nearly 600% within six months. But the surge started from such a low base that nearly all who qualified went without it.

Wegovy has since been approved for metabolic dysfunction-associated steatohepatitis (MASH), and other GLP-1s carry indications for obstructive sleep apnea and chronic kidney disease, each a potential new route to Medicare coverage. This study is the first clear test of what happens when one of those opens up. Researchers examined semaglutide fills across all payers in the six months before and after the change, using national data covering 92% of retail pharmacies.

Wegovy fills rose 136% across all payers compared with the last prepolicy month, reaching 868,301 in September 2024 from 367,371 in February 2024. The policy change itself accounted for an estimated 592,624 additional fills beyond what prior trends predicted. Medicare Part D was the fastest-growing payer, climbing to 32,732 fills from 4,689, with Medicaid, commercial insurance, and cash purchases all rising as well.

Even so, fewer than 1% of the estimated 3.6 million Part D beneficiaries who met the indication's criteria had filled a Wegovy prescription six months in. The surge itself was clearly driven by the new indication. Ozempic and Rybelsus, semaglutide products untouched by the change, showed no growth beyond prior trends.

The analysis drew on IQVIA National Prescription Audit data, comparing fills by brand and payer before and after the coverage expansion; the implementation month itself was excluded. Fills could not be tied to individual patients, so the researchers could not see prescribing indications or what patients paid.

The researchers point to three explanations for the relatively low uptake. Part D plans were hesitant to add a costly drug to formularies, cost sharing could put the drug out of reach even when covered, and prescribers may not have been aware of the new pathway.

"Although our study shows that federal policy change can help increase access to GLP-1s for heart disease, we still have a long way to go to ensure that patients can access and afford these medications as their clinical indications keep expanding," said Christopher Scannell, MD, PhD, of the USC Schaeffer Center and the USC Mann School of Pharmacy and Pharmaceutical Sciences.

Source: Scannell C, et al. (2026 Jul 9) Am J Manag Care. Changes in Semaglutide Fills Following Expanded FDA and Medicare Policies