Wegovy boxes manufactured by Novo Nordisk are seen in a pharmacy in London, UK, on March 8, 2024.
Hollie Adams | Reuters
Medicare may start offering some weight-loss drugs for the primary time – provided they are approved for additional health benefits, the Centers for Medicare and Medicaid Services said Thursday.
This opens the door to a broader discussion of some very fashionable weight loss drugs reminiscent of New NordiskWegovy, which is currently approved within the US to support heart health. Demand for these treatments has skyrocketed over the past 12 months despite high prices and uneven insurance coverage.
Under latest CMS guidelines, Medicare Part D plans can cover obesity treatments which have received approval from the Food and Drug Administration to provide an additional health profit. Medicare prescription drug plans administered by private insurers, called Part D, currently cannot cover weight loss medications alone.
The agency’s guidelines mean Medicare patients will soon find a way to get Wegovy insurance so long as they have obesity, a history of heart disease and are prescribed medications to reduce the chance of heart attacks and strokes. Earlier this month, the Food and Drug Administration approved Wegovy for this purpose.
The guidelines will even open the door to future coverage of other weight-loss drugs, lots of which are currently being tested for additional conditions.
Drugmakers reminiscent of Novo Nordisk, which also produces the diabetes drug Ozempic, AND Eli Lilly are testing their weight-loss drugs for treating fatty liver disease, chronic kidney disease, sleep apnea, and more. To be covered by insurance, these drugs would want to obtain results from late-stage studies after which be submitted to the FDA for approval for these uses.
Wegovy belongs to a category of medication called GLP-1, which mimic a hormone produced within the gut to suppress appetite and help regulate blood sugar levels. The range of those treatments used for weight loss is mixed.
About 110 million American adults are obese, and about 50 million of them are covered by weight-loss medications, a Novo Nordisk spokesman said last week.
Some of the nation’s largest insurers, reminiscent of CVS Health’s Aetna, also cover treatment costs.
But many employers don’t do that. October questionnaire of greater than 200 corporations surveyed by the International Foundation of Employee Benefit Plans (IFEBP) found that only 27% provided GLP-1 coverage for weight loss, compared with 76% that provided coverage for these diabetes medications. Notably, 13% of employers said they were considering weight loss insurance.
Recipe A Act of 2003 established that Medicare Part D plans cannot cover drugs used for weight loss, but this system does cover obesity screening, behavioral counseling and bariatric surgery. A gaggle of bipartisan lawmakers introduced laws this could eliminate the availability, but its fate in Congress is uncertain.
A CMS spokesman told CNBC last week that Medicaid programs can be required to cover Wegova specifically for its latest cardiovascular use. By lawMedicaid must cover just about all FDA-approved drugs, but weight-loss drugs are amongst a small group of medication that might be excluded from coverage. About 1 in 5 state Medicaid programs currently covers GLP-1 drugs for weight loss.
