US Medicare Plans 'Can' Cover Wegovy, CMS Says, But Will They?

Medicare is making clear that Part D ‘can’ cover GLP-1 inhibitors that are approved for cardiovascular indications – but in language that seems to leave plans considerable discretion for now. The formulary review process for 2025 may be a more important milestone for changes.

Plans May Delay Coverage Or Impose Strict Prior Authorization Requirements • Source: Shutterstock

The US Centers for Medicare & Medicaid Services is making it clear to Medicare Part D plans that GLP-1 drugs approved for cardiovascular indications can be covered under the prescription drug benefit – but it may not be clear until 2025 whether the agency actually expects them to do so. 

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