Wego View © Tobias Arhelger – Stock.adobe.com

Following the FDA’s March 8 decision to approve semaglutide (Wegovy) to prevent stroke and heart disease in obese people, CMS announced last week that semaglutide will soon be covered by the Medicare Part D drug program. Multiple media outlets reported that.

However, health plans may require Medicare beneficiaries to undergo step therapy with other drugs before receiving a prescription for Wegovy.

Dr. Marijane Hines is a clinical professor of medicine at the George Washington Weight Loss Clinic in Washington, DC. Almost half of her patients receive Medicare or Medicaid.

“It’s great that Medicare will cover Wegovy for CVD disease because it will improve patient outcomes and reduce overall costs and hospitalizations for heart disease patients,” said Hines. Ta. “But this is secondary prevention, and Medicare should consider covering it.” These drugs are used as primary prevention when patients are obese before developing heart disease. ”

Without insurance, Wegovy’s out-of-pocket costs are about $1,400 per month, forcing patients to seek cheaper options from Mexico or Canada. Gastric bypass surgery is also very expensive without coverage, Hines said, costing nearly $20,000.

Hines also said there is no “magic pill” or procedure that will make the weight melt away. She said behavioral skills and exercise therapy should be introduced in addition to treatment.

Wegovy also has side effects that patients should be aware of. Wegovy has the effect of diluting the taste of fatty foods, and patients may feel sick if they try to eat it after taking it.

“They are still injectable drugs and someone needs to monitor the patient and help them deal with any side effects,” Hines said.

Wegovy was first approved for chronic weight management in adults in June 2021. Approval was then extended to her children over the age of 12.