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Medicare will target certain older adults and other beneficiaries with a history of heart disease after the U.S. Food and Drug Administration approved drug company Novo Nordisk’s application to add cardiovascular benefits to drug labels. There is a possibility that we will start applying Wegobee to.

The Centers for Medicare and Medicaid Services said it notified insurers offering Medicare Part D drug plans that they may be able to cover the drug after the FDA expanded its approval this month.

“CMS has advised Medicare Part D plans that anti-obesity medications (AOMs) that are FDA-approved for additional medically recognized indications may be considered Part D drugs for that specific use. “We have issued guidance stating that this is possible,” CMS said in a statement.

Related: Oprah’s hospitalization sparks new conversation over weight loss drugs Ozempic, Wegovy

Medicare is not allowed by law to cover medications for chronic weight management, but Congress is facing pressure to change that. However, if the same drug receives FDA approval to reduce the risk of heart attacks, strokes, and other serious adverse cardiovascular events, it will be added to Part D formulations for people who already have heart disease. The agency said it may be possible.

According to CMS, insurers can use prior authorization, or prior authorization, to ensure that Wegovy is used for medically recognized indications. The FDA approval applies to adults with cardiovascular disease who are obese or overweight.

The CMS guidance was first reported by the Wall Street Journal.

Wegovy is one of four very popular and very expensive drugs called GLP-1 receptor agonists. Two of them, Novo Nordisk’s Ozempic and Eli Lilly’s Munjaro, are approved to treat people with diabetes. These are more likely to be covered by Medicare Part D plans for people with diabetes or by private insurance companies.

However, Wegovy and Eli Lilly’s Zepbound were only approved as anti-obesity drugs until the FDA recently expanded Wegovy’s approval. As such, they were much less likely to be covered by insurance companies in commercial plans and only by a small number of state Medicaid programs.

Related: Novo Nordisk increases supply of Wigoby after demand-driven shortage of starter doses

CMS also said states must cover Wegobee in Medicaid plans to prevent cardiovascular disease in obese people, but will take steps to control its use, such as requiring patients to try other drugs or treatments first. He said there is a possibility of taking action.

Pharmaceutical companies offer modest discounts on all four drugs, but high list prices put them out of reach for many Americans. Wegovy’s price is $1,349 for 4 weeks, while Zepound’s price is $1,060. Ozempic retails for $969 for a four-week supply, while Mounjaro costs $1,069.

The FDA’s approval was based on a study of 17,000 patients that showed people taking Wegovy had a 20% lower risk of cardiac events than those taking a placebo.

“Wegovy is also approved for use in the prevention of life-threatening cardiovascular events in obese or overweight adults with cardiovascular disease,” said Dr. John Sharetz, director of the FDA’s Division of Diabetes and Dyslipidemia. “This is the first weight-loss drug in the world.” Obesity, the news release said.

See also: These are the first 10 drugs eligible for Medicare price negotiation

A Congressional Budget Office analysis released Wednesday says coverage of WeGovy and similar drugs could reduce other health care spending, but the drugs likely would save the federal government at their current prices. It will cost more than you can afford. Some of the costs would be borne by Medicare enrollees through higher premiums and out-of-pocket costs.

(CNN Wire & 2023 Cable News Network, Inc., a Time Warner Company. All rights reserved. )

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