Medicare to Cover Wegovy for Certain Indications

Wegovy

Medicare is about to get slim.

The U.S. insurance program announced that it can cover Wegovy for certain patients using it for specific indications, Reuters reports.¹ The drug made headlines last year due to its extreme popularity, due to it being a regularly used weight-loss medication for celebrities and influencers.

Previously, the drug was not eligible for Medicare coverage due to it being a weight loss medication. However, the drug does have other uses and it has been approved for other indications. Recently, FDA approved Wegovy to treat certain cardiovascular and heart conditions.

As such, Medicare has announced that members of its Part D plan can access the medication through their plan, as long as it is prescribed specifically to reduce the risk of heart attacks and strokes. Patients do not have to be suffering from diabetes to be prescribed Wegovy for heart issues.

In a statement obtained by Reuters, a spokesperson for the U.S. Centers for Medicare and Medicaid said, “CMS has issued guidance to Medicare Part D plans stating that anti-obesity medications that receive FDA approval for an additional medically accepted indication can be considered a Part D drug for that specific use.”

A spokesperson for the center also told Reuters, "A drug that receives FDA approval for chronic weight management alone would not be considered a Part D drug. If this same drug also receives FDA approval to treat diabetes or reduce the risk of major adverse cardiovascular events in adults with established cardiovascular disease and either obesity or overweight, then it would be considered a Part D drug for those specific uses only.”

According to Reuters, Novo Nordisk is pleased to see Wegovy covered for this indication, the company believes that there is still work to do. The company, which developed and distributes the medication, still wants to see to weight management medication added to the list of medications eligible to be covered by Medicare.

FDA approved Wegovy for cardiovascular risk in early March.²

At the time, Novo Nordisk’s executive vice president, head of North America Operations, and president Doug Langa said in a press release, “Today, we're taking a pivotal step forward in addressing some of the most pressing health issues of our time with the added indication for Wegovy. We recognize how important this moment is for the millions of people who live with excess weight or obesity and known heart disease, and we will continue to advance options that put their needs first. Reducing this risk is a key part of our commitment to driving change for this community, as we work to increase manufacturing capacity to responsibly supply this important medicine."

Source

1. Aboulenein, Ahmed; Patrick Wingrove. Wegovy to be Covered by US Medicare for Heart Disease Patients. Reuters. March 21, 2024. Accessed March 22, 2024. https://www.reuters.com/business/healthcare-pharmaceuticals/wegovy-be-covered-by-us-medicare-heart-disease-patients-2024-03-21/
2. Wegovy Receives FDA Approval for Cardiovascular Risk Reduction in Adults With Known Heart Disease and Overweight or Obesity. Novo Nordisk. March 8, 2024. Accessed March 22, 2024. https://www.prnewswire.com/news-releases/wegovy-receives-fda-approval-for-cardiovascular-risk-reduction-in-adults-with-known-heart-disease-and-overweight-or-obesity-302084454.html