On March 8, 2024, a pharmacy in London, England sold boxed Wegovy produced by Novo Nordisk.
Holly Adams | Reuters
Medicare can start covering certain weight-loss drugs for the first time — as long as they are approved for additional health benefits, the Centers for Medicare and Medicaid Services said Thursday.
This opens the door to expanded coverage of some popular weight loss drugs, such as Novo NordiskWegovy, now approved in the U.S. for heart health. Despite high prices and spotty insurance coverage, demand for these treatments has surged in the past year.
Under new CMS guidance, Medicare Part D plans can cover Food and Drug Administration-approved obesity treatments for additional health benefits. Medicare prescription drug plans run by private insurance companies (called Part D) currently do not cover these weight-loss-only drugs.
The agency’s guidance means Medicare patients will soon be covered by Wegovy as long as they have a history of obesity and heart disease and receive treatments to lower their risk of heart attacks and strokes. Earlier this month, the U.S. Food and Drug Administration approved Wegovy for this purpose.
But the guidance would also open the door to future coverage of other weight-loss drugs, many of which are being tested for other health conditions.
Drugmakers such as Novo Nordisk also make the diabetes drug Ozempic, and Eli Lilly and Company Weight-loss drugs are being studied to treat conditions such as fatty liver disease, chronic kidney disease, and sleep apnea. These drugs need to return late-stage trial results and then be submitted to the FDA for approval for these uses.
Wegovy is part of a class of drugs called GLP-1, which mimic hormones produced in the gut to suppress a person’s appetite and help regulate blood sugar. Coverage for these treatments for weight loss varies.
About 110 million U.S. adults are obese, and about 50 million of them have insurance coverage for weight-loss drugs, a Novo Nordisk spokesman said in a statement last week.
Some of the nation’s largest insurance companies, such as CVS Health’s Aetna, also cover these treatments.
But many employers don’t think so.October poll The International Foundation for Employee Benefit Plans (IFEBP) surveyed more than 200 companies and found that only 27% provided coverage for GLP-1 weight-loss drugs, while 76% covered these drugs to treat diabetes. Notably, 13% of employers said they were considering underwriting bariatric insurance.
a stipulation Laws 2003 It is determined that Medicare Part D plans do not cover medications for weight loss, but the plan does cover obesity screenings, behavioral counseling, and bariatric surgery.A group of bipartisan lawmakers introduced legislation That would eliminate the provision, but its fate in Congress is far from certain.
A CMS spokesperson told CNBC last week that Medicaid will be required to specifically cover Wegovy’s new cardiovascular uses.go through law, Medicaid must cover nearly all FDA-approved drugs, but weight loss treatments are among a small group of drugs that can be excluded from coverage.About one-fifth of state Medicaid programs Currently covered GLP-1 drugs for weight loss.
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