Boxes of Wegovy made by Novo Nordisk are seen at a pharmacy in London, Britain March 8, 2024.
Hollie Adams | Reuters
Medicare can start covering certain weight reduction drugs for the primary time — so long as they’re approved for an added health profit, the Centers for Medicare and Medicaid Services said Thursday.
That opens the door for broader coverage of some highly popular weight reduction medications reminiscent of Novo Nordisk‘s Wegovy, which is now approved within the U.S. for heart health. Those treatments have skyrocketed in demand over the past 12 months despite their hefty price tags and spotty insurance coverage.
Under the brand new CMS guidance, Medicare Part D plans can cover obesity treatments that receive Food and Drug Administration approval for a further health profit. Medicare prescription drug plans administered by private insurers, often called Part D, currently cannot cover those drugs for weight reduction alone.
The agency’s guidance means Medicare patients could soon get coverage for Wegovy, so long as they’ve obesity and a history of heart disease and are prescribed the treatment to cut back their risk of heart attacks and strokes. Earlier this month, the Food and Drug Administration approved Wegovy for that purpose.
The guidance also will open the door to future coverage of other weight reduction medications, a lot of that are being tested for extra health conditions.
Drugmakers reminiscent of Novo Nordisk, which also makes the diabetes drug Ozempic, and Eli Lilly are studying their weight reduction medicines as treatments for fatty liver disease, chronic kidney disease, sleep apnea and more. To be covered, those drugs would wish to return late-stage trial results after which be submitted for FDA approval for those uses.
Wegovy is an element of a category of medicine called GLP-1s which mimic a hormone produced within the gut to suppress an individual’s appetite and help regulate blood sugar. Coverage for those treatments when used for weight reduction is a mixed bag.
Roughly 110 million American adults reside with obesity and roughly 50 million of them have insurance coverage for weight reduction drugs, a spokesperson for Novo Nordisk said in a press release last week.
A few of the nation’s largest insurers, reminiscent of CVS Health’s Aetna, also cover the treatments.
But many employers don’t. An October survey of greater than 200 firms by the International Foundation of Worker Profit Plans, or IFEBP, found only 27% provided coverage for GLP-1s for weight reduction, compared with the 76% that covered those drugs for diabetes. Notably, 13% of employers indicated they were considering coverage for weight reduction.
A provision of a 2003 law established that Medicare Part D plans cannot cover drugs used for weight reduction, but this system does cover obesity screening, behavioral counseling and bariatric surgery. A gaggle of bipartisan lawmakers have introduced laws that might eliminate the availability, but its fate in Congress is removed from certain.
A CMS spokesperson told CNBC last week that Medicaid programs could be required to cover Wegovy specifically for its latest cardiovascular use. By law, Medicaid must cover nearly all FDA-approved medications, but weight reduction treatments are amongst a small group of medicine that might be excluded from coverage. Around 1 in 5 state Medicaid programs currently cover GLP-1 drugs for weight reduction.
