Robin Foster HealthDay Reporter

FRIDAY, March 22, 2024 (HealthDay News) — Medicare will cover patients using the popular weight loss drug Wegovy if they also have heart disease, U.S. officials said Thursday. Announced.

The move comes after the U.S. Food and Drug Administration earlier this month approved drug company Novo Nordisk’s application to add cardiovascular benefits to the drug’s label.

As a result, the U.S. Centers for Medicare and Medicaid Services (CMS) announced that it has notified insurers offering Medicare Part D drug plans that they can cover the drug if another use is approved.

“CMS has issued guidance to Medicare Part D plans regarding anti-obesity drugs that states: [AOMs] “Those that receive FDA approval for additional medically recognized indications may be considered Part D drugs for that specific use,” CMS said in a statement. CNN report.

Tricia Newman, a Medicare policy expert at KFF, said Part D plans could begin covering the drug “sometime this year.” Associated Press.

“Medicare plans may be reluctant to act quickly to cover Wegobee given the relatively high prices, especially since premiums cannot be adjusted until next year,” she said. Ta. Wegovy costs just over $1,300 per month.

Even if plans offer coverage, it can require high copays, prior authorization, or step therapy, where patients must try lower-cost drugs before moving on to new treatments. Newman pointed out.

Wegovy is one of four popular weight loss drugs called GLP-1 receptor agonists. Two of them, Novo Nordisk’s Ozempic and Eli Lilly’s Mounjaro, are approved to treat people with diabetes and are likely to be covered by insurance companies. CNN report.

However, Wegovy and Eli Lilly’s Zepbound were only approved as weight-loss drugs until the FDA recently approved Wegovy’s expanded heart benefits. This means that your chances of being covered by insurance are much lower.

Medicare is not allowed by law to cover weight loss drugs, but Congress is facing pressure to change that. CNN report. But if the drug also receives FDA approval to reduce the chance of heart attacks, strokes and other cardiovascular events, it could be added to the Part D program for heart disease patients, CMS said.

CMS also said states must apply Wegovy to Medicaid plans to prevent heart disease in obese people, but will take steps to control its use, such as requiring patients to try other drugs and treatments first. He said that he could also take measures. CNN report.

Pharmaceutical companies offer modest discounts on all four drugs, but high list prices put them out of reach for many Americans. CNN report.

One remaining obstacle to widespread use is the drug’s limited supply, which has been in short supply for more than a year, according to the FDA. Novo He said Nordisk officials are working to increase production and access. AP report.

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