Updated on March 22, 2024 at 12:18 PM ET

For the first time, Medicare will allow Part D plan enrollees to cover one of the new blockbuster weight loss drugs.

A new policy announced this week by the Centers for Medicare and Medicaid Services says the plan may cover Wegovy if it’s prescribed to prevent heart attacks or strokes.

Wegovy is a GLP-1 agonist, a type of obesity drug that is expected to make a big difference in weight loss. These act on hormones and the brain, significantly reducing appetite among other things.

But Medicare is prohibited from paying for weight-loss treatments, so seniors must pay for their medications out of pocket or use supplemental insurance. In early March, the Food and Drug Administration expanded its approval of Wegovy, announcing that the drug can be used to reduce the risk of cardiovascular death, heart attack, and stroke in people with cardiovascular disease and who are overweight or obese. did.

In clinical trials, Wegovy was found to reduce the risk of cardiovascular events by 20% in heavy patients.

The findings prompted CMS to change its Medicare Part D drug program to cover Wegovy, but noted that this only applies to patients who suffer from both weights. and Heart disease. In other words, out-of-pocket costs for the injections can be well over $1,000 a month and are not covered for enrollees whose sole purpose is to lose weight.

The new guidance would also apply to state Medicaid plans, requiring Wegobee coverage for patients who are overweight and at high risk for heart disease.

Obesity doctor Angela Fitch says the move to cover obesity, even if it’s for a limited number of patients, remains important. She is president of the Obesity Medicine Society, an organization that advocates for treatment.

“It’s certainly a big step up from no coverage at all,” she says. “At least now people with a history of heart disease will be covered,” she says. “Hopefully that will trickle down to covering everyone who is overweight or obese.”

And because Medicare sets standards for coverage across the board, the move could ultimately impact more patients, Fitch noted. “My hope is that commercial insurance will follow suit.”

“CMS is committed to ensuring people have access to treatments and treatment options that improve health outcomes,” a CMS spokesperson said in a statement.

Medicare guidance could also expand the use of other similar drugs. It states that anti-obesity drugs approved by the FDA for additional conditions in addition to weight management can be considered Part D drugs for that specific use. For example, if one of your medications is approved by the FDA to treat diabetes or prevent cardiovascular disease, your Medicare Part D plan may cover that use.

However, CMS may require prior approval to ensure that it is used only for approved purposes.

Novo Nordisk, the maker of Wegobee, said in a statement that it was “encouraged” by CMS’ new guidance, which expands Part D coverage to “obesity drugs used for chronic weight management.” He said he was looking forward to it.

Pharmaceutical companies are among those calling on Congress to expand coverage of obesity treatment.

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