Medicare covers certain weight loss drugs

Currently, due to federal law, Medicare Part D plans cannot cover bariatric drugs intended solely for weight loss. But new guidance from CMS says Medicare Part D plans can cover anti-obesity drugs provided they receive approval for “additional medically recognized indications.”

“for example, F.D.A. “Chronic weight management-only approvals are not considered Part D drugs,” CMS said.[But] If this same drug was also approved by the FDA to treat diabetes and reduce the risk of serious cardiovascular events in adults who already have cardiovascular disease and are obese or overweight, that specific use It would be considered a Part D drug used only. ”

Earlier this month, the FDA approved Wegovy to reduce the risk of heart attack and stroke in patients with a history of cardiovascular disease and a body mass index above a certain threshold. A recent clinical trial found that Wegovy reduced the risk of serious cardiovascular events by 20% compared to a placebo.

CMS notes that its new guidance will not change the coverage of other drugs with the same active ingredient as Wigovy, such as Ozempic and Munjaro, which are currently approved and covered for the treatment of type 2 diabetes. did.

reaction

Juliet Cubansky, Deputy Director of Medicare Policy Programs KFFsaid Part D plans may use Wegovy’s coverage as a selling point during this fall’s public offering period.

“This could be a selling point for plans that decide to cover it,” she said. “There’s a lot of demand for these drugs.”

However, the high price of Wegovy could lead to additional costs for Medicare Part D beneficiaries, and Cubansky noted that Wegovy “remains a relatively expensive drug.”

“This decision is a major victory for manufacturers in asserting that GLP-1 is not just a cosmetic drug, but also effective in preventing chronic disease,” he said. advisory body’Gabriela Marmolejos. “However, as noted in our SELECT trial expert insights, access will remain an issue due to high costs, pre-approval hurdles, and supply constraints.”

Currently, Wegovy’s list price is over $1,300 per month. According to an analysis published last year in a magazine, New England Medical Journalnearly 10 million Medicare beneficiaries are obese, and paying for just one-tenth of eligible members to receive Wegovy could increase Part D spending by $26.8 billion, which is equivalent to more than 18% of the annual payment amount.

The increased spending could result in higher premiums for Part D beneficiaries, Cubansky said.

Additionally, the high cost of the drug may make it subject to drug price negotiations under the Inflation Control Act. “We’re interested to see how these potential price negotiations are resolved,” said advisory board member Carla Marlatt.

In the future, Marmolejos will novo nordisk We are pursuing other indications, particularly those related to heart failure, that could further expand Medicare coverage of these drugs. (Loftus, wall street journal, March 21st.gilbert washington post, March 21st. Frieden, today’s med page3/21)