Medicare Will Now Cover Wegovy for Heart Disease — but Not Weight Loss

Patients using Medicare were previously denied coverage for the FDA-approved weight loss drug Wegovy, no matter the circumstance

<p>George Frey/Bloomberg via Getty</p> Wegovy brand semaglutide medication

George Frey/Bloomberg via Getty

Wegovy brand semaglutide medication

Medicare has officially expanded its coverage to include Wegovy for patients at risk of heart disease.

Enrollees in Part D plans will now have access to the popular weight loss drug when specifically prescribed as a treatment to prevent strokes and heart attacks, per the Centers for Medicare and Medicaid Services (CMS).

Per NPR, Wegovy is categorized as a GLP-1 agonist, which means it relies on hormones and the brain to reduce one's appetite.

Medicare, which provides coverage for more than 65 million people in the U.S., according to data from the CMS, was previously barred from covering any form of weight loss drug. However, a recent ruling from the Food and Drug Administration expanded the approval to allow Wegovy to be prescribed, only if the patient is overweight, to reduce heart disease risk.

<p>Getty</p> A stethoscope


A stethoscope

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Their decision was made after a 2023 clinical trial showcased the drug reducing the risk of heart problems for overweight people by 20 percent, per The Washington Post.

That same decision to allow Wegovy coverage also applies to state Medicaid plans. However, as of the time of writing, Medicare will not cover the drug if it is being used solely to manage weight.

The CMS told NPR in a statement that they are "committed to ensuring that people have access to treatments and treatment options that improve health outcomes."

Related: Stars Who've Spoken About Ozempic — and What They've Said

Wegovy, like related semaglutide drug Ozempic, has become popular among celebrities for weight loss. Oprah Winfrey, Keke Palmer, Amy Schumer and others have addressed its recent proliferation in Hollywood and beyond.

Ania Jastreboff M.D., PhD., told PEOPLE in January, "The most common side effects with these medications are nausea and diarrhea, and sometimes you can have vomiting or constipation."

Jatreboff also noted, "If the medication is increased too quickly, then these side effects are more likely to occur."

Medicare's acceptance of new drugs for coverage typically comes first before private insurance companies begin paying. It remains to be seen when or if others follow Medicare's lead and offer coverage options for Wegovy.

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