Wegovy, a semaglutide medication, will be covered by Medicare.
George Frey/Bloomberg via Getty Images
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George Frey/Bloomberg via Getty Images
Wegovy, a semaglutide medication, will be covered by Medicare.
George Frey/Bloomberg via Getty Images
Medicare drug plans can now cover the obesity drug Wegovy when prescribed to prevent heart attacks and strokes, according to a new policy issued this week from the Centers for Medicare and Medicaid Services.
Medicare is prohibited from paying for weight-loss treatments. But the Food and Drug Administration expanded the approval of Wegovy in early March to say the drug can be used to reduce the risk of cardiovascular death, heart attack and stroke in people with cardiovascular disease and either overweight or obesity.
In a statement, a CMS spokesperson said: “CMS is committed to ensuring that people have access to treatments and treatment options that improve health outcomes.”
The Medicare guidance could also expand the use of other similar medicines. It states that anti-obesity medications that receive FDA approval for an additional condition other than weight-management alone, can be considered a Part D drug for that specific use. For example, if one of the drugs receives FDA approval to treat diabetes or prevent cardiovascular disease, Medicare Part D plans may cover it for that use.
However CMS specified they may also require prior authorizations to ensure that is being used only for the approved use.
In a statement, Wegovy’s maker Novo Nordisk said it was “encouraged” by the new guidance from CMS but said it hopes to see Part D coverage expanded for “obesity medicines when used for chronic weight management.”
