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kgirl
Contributor ⭐
February 17, 2025

Weight Loss Drugs not being covered

  • February 17, 2025
  • 8 replies
  • 4442 views

My physician has prescribed Wegovy for increasing adverse heart related conditions which continue to deteriorate. I have AARP Preferred Part D drug plan and was denied despite showing my Calcium Score being 191 along with elevated heart rate, angina, dyslipedemia and many other heart related symptoms in addition to a BMI of 34, sleep apnea and elevated risk of stroke. With this drug proven to improve my chances of improving my health and prevent a stroke or heart attack, why to I get denied coverage? Do I have to experience an adverse heart event to be approved?

      8 replies

      GailL1
      GailL1
      Community Champion ⭐⭐⭐
      February 18, 2025

      @kgirl 

      Was Wegovy on the plans formulary?  

      IT‘S ALWAYS SOMETHING . . . . .. . . . Roseanne Roseannadanna
      SummerOnTheWay1
      SummerOnTheWay1
      March 5, 2025

      📎  [Wednesday 3/5/25] @GailL1 , out of curiousity - are these types of drugs (weight loss) covered by Medicare? NOT prescribed any, just wondering. As usual, NO pressure to respond. Take care, Nicole  👵

       

      [*** @GailL1 wrote 2/18/25:

      @kgirl 

      Was Wegovy on the plans formulary?  ***]

      GailL1
      GailL1
      Community Champion ⭐⭐⭐
      March 5, 2025

      @SummerOnTheWay1 

      As of now - some are covered BUT NOT for weight loss - coverage is extended ONLY if they are prescribed for a medically accepted indication OTHER THAN weight loss.  For example, Wegovy (semaglutide) is now approved to reduce the risk of cardiovascular events in adults who are obese or overweight.

      ASPE.gov - 11/24/2024 - Medicare Coverage of Anti-Obesity Medications  

       

      As of August 2024, Ozempic, Mounjaro, Rybelsus, and Wegovy are covered Part D drugs for the treatment of type 2 diabetes and cardiovascular disease. 
       
      Some of the others are not because they haven't been approved for anything other than weight loss and Medicare does not cover drugs just for weight loss.     
       
      Some or maybe all of those that are approved maybe only available on an enhanced Part D plan - just check the formulary
                                                                                   
      Drug Active IngredientWeight Reduction Type 2 Diabetes  Mellitus*Risk Reduction of CV  Events 
      Mounjaro tirzepatide         X 
      Ozempicsemaglutide         X     X
      Rybelsussemaglutide         X 
      Saxenda  liraglutide            X  
      Victoza   liraglutide          X      X
      Wegovysemaglutide            X       X
      Zepbound       tirzepatide             X  


       





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