The FDA expanded Wegoby’s regulatory label after a clinical trial last year found the drug reduced the risk of heart disease in overweight people by 20 percent.

As a result, a spokesperson for the Centers for Medicare and Medicaid Services said that Medicare Part D drug benefit plans, which are run by private companies, do not offer drug benefit plans that reduce the risk of heart failure in overweight patients with a history of cardiovascular disease. It is said that it can cover Wegovy. But a spokesperson said in a statement that the drug is not typically covered by weight management alone.

The new policy would apply to all anti-obesity drugs that have FDA approval for what CMS calls “additional medically recognized indications,” such as reducing the risk of heart failure. . Wegovy is the first drug to be approved by the FDA for that purpose, and analysts expect at least some Medicare Part D plans to cover it.

“CMS is committed to ensuring that people have access to treatments and treatment options that improve health outcomes,” the agency said.

Novo Nordisk said in a statement that it was “encouraged to see recent guidance from CMS,” adding that “there is still work to do” as Wigoby is not yet covered by Medicare when used solely for weight management. Ta.

The expansion of insurance coverage is another milestone for Wegovy, which, like its diabetes drug Ozempic, has become a cultural sensation and blockbuster. CMS’s move could also put pressure on private insurance companies to cover expensive drugs, researchers and Wall Street analysts said.

Wegovy works by mimicking a naturally occurring hormone called glucagon-like peptide 1 (GLP-1). This hormone slows stomach emptying and sends signals to the brain that you are full. It’s become so popular that Novo Nordisk has struggled to keep up with demand, the FDA has declared a shortage of the drug, and drugmakers have taken extraordinary steps to ramp up production.

Still, the drug’s high price has made some insurance companies and employers reluctant to cover it, and Medicare plans may face similar considerations. KFF, a health policy research organization, cited a recent study that found that if just 10% of Medicare beneficiaries took advantage of his Wegovy, it would cost the federal program about $13.6 billion.

“This could be a selling point for plans that decide to cover it. There’s a lot of demand for these drugs,” said Juliette Cubansky, associate director of KFF’s Medicare policy program. He mentioned how private Medicare plans are trying to attract seniors. “On the other hand, it is still a relatively expensive drug.”