Medicare can cover Eli Lilly’s Zepbound to treat sleep apnea: Health Department agency | Wilnesh News

Medicare drug plans now cover Eli Lilly and Companyblockbuster weight loss pill Zepp Bond CNBC confirmed Wednesday that the patient suffered from obstructive sleep apnea.

This opens the door to wider use of Zepbound, which is currently not covered by Medicare and many other weight loss insurance plans. Demand for injections surged last year despite rough prices $1,000 per month price tag Before insurance.

A spokesperson for the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services said in a statement to CNBC that “current Medicare Part D and Medicaid coverage rules apply” to Zepbound landmark approval December is the most common sleep-related breathing disorder.

A CMS spokesman said Medicare Part D plans can only cover obesity drugs for other medically acceptable purposes approved by the U.S. Food and Drug Administration. guide. The spokesman added that Part D plans may consider using prior authorization — a process in which providers must first get approval from their insurers — for these drugs to ensure they are used for a specific purpose.

The FDA approved Zepbound on Dec. 20 for patients with obesity and moderate-to-severe obstructive sleep apnea (OSA), a disorder of breathing during sleep due to narrowing or obstruction of the airways. This makes Zepbound the first drug treatment option for the estimated 20 million patients with the disease, according to Eli Lilly.

Medicare Part D plans also allow coverage Novo NordiskThe weight loss drug Wegovy is for Other approved uses:Reduces cardiovascular risk. Wegovy and Zepbound’s diabetes counterparts — Ozempic and Mounjaro, respectively — are covered by Medicare and most insurance plans.

Novo Nordisk and Eli Lilly are both studying their weight-loss drugs to treat fatty liver disease, chronic kidney disease, sleep apnea and other conditions. To gain coverage, these drugs need to return late-stage trial results and then be submitted to the FDA for approval for these uses.

Meanwhile, state Medicaid coverage of Zepbound and other obesity drugs depends on how they are prescribed and whether the manufacturers sign specific agreements. Medicaid Drug Rebate Agreementaccording to the spokesperson.

Under an agreement with the secretary of Health and Human Services, manufacturers agree to provide rebates to states in exchange for Medicaid coverage of their drugs. States share rebates with the federal government.

If Zepbound is used in OSA and Eli Lilly has signed a Medicaid drug rebate agreement, state Medicaid plans must cover Zepbound, the spokesperson said.

But if Zepbound is prescribed for weight loss, state Medicaid plans don’t need to cover it.

Biden administration in November recommended A rule that would allow Medicare and Medicaid to cover weight-loss drugs for obese patients. The rule would give millions of people access to weekly injections but would cost taxpayers up to $35 billion over the next decade.

It’s unclear whether President-elect Donald Trump’s administration will pursue the rule.