The Wall Street Journal (subscription) reports that three of the nation’s largest health insurance companies will soon make top-of-the-line weight loss drugs available to certain people with heart-related conditions enrolled in Medicare. He said he plans to start making payments.

what happened: CVS Health, Elevance Health, and Kaiser Permanente have announced that Novo Nordisk’s WeGoBe will help reduce the risk of heart attacks and strokes in people with cardiovascular disease, who meet weight standards and are covered by Medicare drug benefit plans. announced that it would compensate. ”

• The class of weight loss drugs to which Wegovy belongs was previously excluded from Medicare coverage by U.S. law.

Why it’s important: The decision will “relieve the financial burden” on people who pay out-of-pocket for Wegoby and encourage use of the drug among those who cannot or do not want to pay the full price. There is a possibility that

• Nearly two-thirds of U.S. adults are overweight or obese, according to NAM’s recent report, “Manufacturers on the Frontline of Communities: A Deeper Commitment to Health Care.”
• Excess weight and obesity are associated with increased health care costs for both employers and their workers. They also “increase the likelihood of other illnesses” and affect “productivity and job performance,” according to the study, pointing to weight loss drugs as part of the solution.

Why it happened: New guidance released last week by the Centers for Medicare and Medicaid Services says that Medicare Part D plans run by private insurers “may also cover anti-obesity drugs if approved for additional medically acceptable use.” It is said that

• This is the case with Wegovy, which the Food and Drug Administration recently approved to reduce the risk of heart attack and stroke in people with a history of heart disease and body mass index above certain thresholds.

but … Use of Wegovy “solely for weight loss” remains exempt from CMS guidance.