(Bloomberg) -- Medicare’s recent decision to cover Novo Nordisk A/S’s blockbuster obesity shot Wegovy for heart disease will possibly subsidize the drug for some 3.6 million people, according to a new study from Kaiser Family Foundation.

The US federal health insurance program for people over 65 and those with disabilities has yet to cover Wegovy, or any drug, specifically for weight loss. In March, the US government allowed Novo to market Wegovy for heart disease after a study showed it reduced the risk of heart attacks and strokes by 20%. Later that month, the government agency that runs Medicare told prescription drug plans that they could cover the anti-obesity drug for patients who have heart disease and are overweight. 

The KFF study, released Wednesday, is the first to illuminate exactly how many patients fit this description. The study showed some 10 million Americans on Medicare have heart disease and 13.7 million have obesity, but just 3.6 million of those people have both conditions.

Investors have been trying to figure out exactly how many patients will newly qualify for Wegovy in order to ballpark Novo’s sales and potentially those of its rival Eli Lilly & Co., if its weight-loss drug Zepbound also proves effective for heart disease. Of the 3.6 million people, the KFF study points out some 1.9 million also have diabetes, which could qualify them for a drug in the same class as Wegovy, known as GLP-1s. 

Read more: Why Weight-Loss Drugs Are Billion-Dollar Blockbusters: QuickTake

Drugmakers are expediting research into GLP-1s for a plethora of health conditions including Alzheimer’s and sleep apnea to both expand the use of the drugs and get broader insurance coverage. So far, though, drug companies have found it hard to get insurance coverage for weight loss. 

The fact that Medicare isn’t covering the drugs for weight loss “reflects bias against obesity as a disease at the governmental level,” said Timothy Garvey, an obesity expert at the University of Alabama at Birmingham.

Medicare spending on Ozempic in 2022 reached $4.6 billion, making it one of the top-selling drugs in Medicare Part D plans, according to KFF. Ozempic is also a GLP-1 drug, like Wegovy, but it’s approved for use in diabetes. 

The new KFF study found a patient’s out-of-pocket cost could reach up to $430 for a month’s supply, which could make them costly for people on Medicare. Caps on out-of-pocket expenses in Medicare could reach $3,300 in 2024 and $2,000 in 2025, meaning patients could face tough economic decisions even with Medicare plans covering the drug. 

Part D plans may also be reluctant to add coverage for Wegovy in part because of its cost, the study added. 

--With assistance from Madison Muller.

©2024 Bloomberg L.P.