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GailL1
GailL1
Community Champion ⭐⭐⭐
May 1, 2024

Wegovy & other GLP-1 drugs to get coverage under Medicare Part D

  • May 1, 2024
  • 2 replies
  • 10508 views

  

  Get ready for your Part D premiums to escalate -

 

  KFF.org - 04/24/2024 - A New Use Opens the Door for Medicare Coverage for MILLIONS

 

from the link ~ lots more at the link too

The FDA recently approved a new use for Wegovy (semaglutide), the blockbuster anti-obesity drug, to reduce the risk of heart attacks and stroke in people with cardiovascular disease who are overweight or obese. Wegovy belongs to a class of medications called GLP-1 (glucagon-like peptide-1) agonists that were initially approved to treat type 2 diabetes but are also highly effective anti-obesity drugs. The new FDA-approved indication for Wegovy paves the way for Medicare coverage of this drug and broader coverage by other insurers. Medicare is currently prohibited by law from covering Wegovy and other medications when used specifically for obesity. However, semaglutide is covered by Medicare as a treatment for diabetes, branded as Ozempic.

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    2 replies

    D
    DanaK459286
    Contributor ⭐
    May 7, 2024

     If you have United Healthcare insurance, good luck with them covering it.  They won't cover Ozempic which worked for my diabetes and I've tried their approved Trulicity and Bydureon with no luck.  Have tried to get a tier reduction but still can't afford the 40% co-pay.  And, just try calling in--always a non-helpful foreign speaking customer service who reads an answer out of a book.  Why AARP is in bed with United Healthcare as they care more about their shareholders than customers.

      GailL1
      GailL1Author
      Community Champion ⭐⭐⭐
      May 7, 2024

      @DanaK459286 

      One of the reasons why a beneficiary can change their

      • Medicare Advantage plan(MA),
      • Medicare Advantage plan w/linked Prescription Drug coverage (MAPD),
      • or their free-standing Medicare Prescription Drug plan,

      EVERY YEAR during open enrollment is because our healthcare needs do change,  Thus a beneficiary needs to find the best plan to fit their needs in prescription drugs and medical needs.

       

      Open enrollment starts October 15 for plans to be effective for January 01 of the next year.

      Medicare.gov - The Basics - Enrollment periods  

       

      You should be able to find this specific med on another Med D plan if it is what you need rather than another one of the GLP-1 meds.

       

      All Part D plans must include at least two drugs from most categories(classifications) and must cover all drugs available in the following categories:
      • HIV/AIDS treatments.
      • Antidepressants.
      • Antipsychotic medications.
      • Anticonvulsive treatments for seizure disorders.
      • Immunosuppressant drugs.
      • Anticancer drugs (unless covered by Part B)

       

      IT‘S ALWAYS SOMETHING . . . . .. . . . Roseanne Roseannadanna
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