Medicare will present protection for Wegovy for sufferers with an elevated threat of coronary heart assault, stroke or different severe cardiovascular issues, an company spokesperson mentioned Thursday.The choice, specialists say, may grant tens of millions of sufferers entry to the favored but costly weight reduction remedy.Medicare, which presently supplies medical health insurance to greater than 65 million individuals within the U.S., has lengthy been barred from paying for weight reduction medication.Earlier this month, nonetheless, the Meals and Drug Administration expanded the approval for Wegovy, saying that it may be prescribed to people who find themselves chubby or have weight problems to cut back their threat of coronary heart illness.The change prompted the Facilities for Medicare and Medicaid Companies to contemplate protection as a result of lowering coronary heart illness threat is a medically accepted use beneath federal legislation, the spokesperson mentioned. Medicare will nonetheless not cowl Wegovy if it is just getting used for weight administration, the spokesperson mentioned. Medicaid, the federal medical health insurance program for individuals with low incomes, may also be required to cowl Wegovy to cut back coronary heart illness threat.Lawrence Gostin, director of the O’Neill Institute for Nationwide and International Well being Legislation at Georgetown College, mentioned Medicare offering protection for Wegovy is “transformational.”However doing so may undermine Medicare’s “monetary stability,” Gostin mentioned. The drug carries a listing value of round $1,200 a month, and plenty of sufferers will doubtless need a prescription.A survey from the College of Michigan Nationwide Ballot on Wholesome Getting old in December discovered about 3 in 4 older adults imagine Medicare ought to cowl weight reduction medicines.A weblog publish from the Congressional Finances Workplace final October mentioned that if Medicare did cowl weight reduction medicines similar to Wegovy, the web value to this system “could be important over the following 10 years.”“There may very well be a slippery slope the place Medicare finally ends up paying for the drug for use for weight reduction functions,” Gostin mentioned. “That may bankrupt Medicare and trigger a taxpayer revolt.”Juliette Cubanski, deputy director of the Medicare coverage program at KFF, a nonpartisan group that research well being coverage points, mentioned that whereas Medicare will not cowl the drug solely for weight reduction, many individuals with coronary heart illness are chubby or have weight problems. “We may see Medicare sufferers with each circumstances get protection of this drug for its coronary heart well being advantages,” Cubanski mentioned. “That’s doubtlessly a giant deal given the big demand for this drug even within the absence of many insurers masking it.”The drug can be lined beneath Medicare Half D, which covers the price of medicines individuals take at house, the spokesperson mentioned.It’s not clear how non-public insurance coverage firms that supply supplemental Half D protection will reply, Cubanski mentioned, noting that plans do have the flexibility so as to add new medication to the checklist of medicine they cowl in the course of the yr, “however given the price of this drug, plans may not need to be the primary movers.”