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Medicare will now cover the popular weight-loss drug Wegovy if patients have heart disease, U.S. officials announced Thursday.
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 announced to Medicare Part D plans that anti-obesity medications (AOMs) that have received FDA approval 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, CNN reported. .
Tricia Newman, a Medicare policy expert at KFF, told The Associated Press that Part D plans could begin covering the drug “sometime this year.”
“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 Munjaro, are approved to treat people with diabetes and will likely be covered by insurance companies, CNN reported.
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 reported. 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 include Wegoby in 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. CNN reported that he said there was a possibility that he would take action.
CNN reports that drug companies are offering some discounts on all four drugs, but high list prices put them out of reach for many Americans.
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. According to the Associated Press, Novo’s Nordisk officials said they are working to increase production and access.
For more information:
For more information on weight loss drugs, visit the Obesity Medicine Association.
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Quote: If your patient has heart disease, Medicare covers Wegovy (March 22, 2024) https://medicalxpress.com/news/2024-03-medicare-wegovy-patients-heart-disease.html Retrieved March 23, 2024 from
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