Medicare Covers Wegovy for Heart Disease Prevention

(CTN News) — For the first time, Medicare Part D will cover one of the new blockbuster weight-loss drugs.

According to a new policy issued this week by the Centers for Medicare and Medicaid Services, Wegovy may now be covered by Medicare and Medicaid plans when it is prescribed as a treatment to prevent heart attacks and strokes.

The use of GLP-1 agonists, a class of obesity drugs that aim to dramatically reduce appetite by acting on hormones and the brain, significantly contributes to weight loss.

Although Medicare does not pay for weight-loss treatments, seniors have had to purchase the drugs out of pocket or use supplemental insurance to get the medications they need.

In early March, the Food and Drug Administration expanded Wegovy’s approval to say that it can be used to reduce the risk of cardiovascular death, heart attack, and stroke in people with cardiovascular disease and either overweight or obesity.

According to clinical trials, Wegovy reduced cardiovascular events by 20% in people with higher weights.

CMS changed its Medicare Part D drug program to cover Wegovy but noted that it only applies to patients with both heart disease and weight. Thus, enrollees who are only trying to lose weight won’t be covered for injections, which can cost up to $1,000 a month.

Under the new guidance, Medicaid plans will also need to cover Wegovy for patients with higher weights and heart disease risks.

Angela Fitch, president of the Obesity Medicine Association, advocates for treating obesity, said the move to cover it even for a limited subset of patients is significant.

She says it’s a big step forward from no coverage at all. “At least we’ll be covered for those with a history of heart disease now. It’s going to trickle down to covering everyone who’s overweight or obese, right?”

This move could affect more people since Medicare sets the standard for insurance coverage. “I hope commercial insurance will follow.” says Fitch.

A CMS spokesperson said, “CMS is committed to ensuring people can get treatments that improve their health outcomes.”

Medicare guidance may also expand the use of similar medicines. Anti-obesity drugs that are FDA-approved for a specific condition, not just weight loss, can be treated as Part D drugs. If one of the drugs gets FDA approval to treat diabetes or prevent cardiovascular disease, Medicare Part D plans might cover it.

However, CMS said they might also need prior authorizations to be sure it’s being used only for approved purposes.

Wegovy’s maker, Novo Nordisk, said it was encouraged by CMS’s new guidance but hoped it would expand Part D coverage for “obesity medicines used for chronic weight management.”

Congress should expand obesity treatment coverage, the drug maker says.