US Government Expands Medicare Coverage to Include Weight-Loss Drug Wegovy

Wegovy addition to Medicare program
Wegovy addition to Medicare program. Credit | AP

United States – US officials announced on Thursday that the government will also disburse the weight-loss drug Wegovy by incorporating it into its health insurance program, Medicare. National health insurance, Such, also covers heart disease.

That comes from the FDA approval that the drug manufacturing company Novo Nordisk drew for having added traceable cardio effects to the measures of the drug, as reported by The Associated Press.

Medicare Part D Coverage Guidance

In that light, the U.S. Centers for Medicare and Medicaid Services (CMS) has already told insurers providing Medicare Part D drug plans that they could cover them if approved for other uses.

“CMS has issued guidance to Medicare Part D plans stating that anti-obesity medications [AOMs] that receive FDA approval for an additional medically accepted indication can be considered a Part D drug for that specific use,” CMS said in a statement, CNN reported.

In her speech to the Associated Press, Tricia Neuman, the expert on Medicare policy at KFF, confirmed that Part D plans will begin covering the drug “any time this year.”

Challenges and Considerations

“Medicare plans may be reluctant to move quickly to cover Wegovy given its relatively high price, particularly because they won’t be able to adjust premiums before next year,” she said. Wegovy costs just over USD 1,300 a month.

Plans might approve the coverage, but this provision will require higher co-paying, prior authorizations, or step therapy, where a patient needs to try out a cheaper drug before moving to the new treatment, Neuman added.

Wegovy is an agonist of the GLP-1 receptor, working as one of the four main weight-loss drugs. Both Eli Lilly’s Mounjaro and Novo Nordisk’s Ozempic are approved for the cure of diabetes patients and are more likely to be covered by insurers, as per CNN.

Impact on Coverage Landscape

However, Wegovy and Eli Lilly’s were only cleared for overweight people until the FDA gave Wegovy new approval for the heart health of the users. They represent individuals who represent much lower coverage by insurance.

According to CNN, the US federal government, through Medicare, which is not permitted by law to cover drugs that help with weight loss, is under society’s pressure to revise this law. However, getting the drug additionally approved by the FDA to be high in reducing the chances of heart attacks, strokes, and other cardiovascular disorders makes it easy to be listed therein for persons with heart diseases, according to the CMS.

The CMS also mentioned that states should provide coverage to Wegovy in their Medicaid plans to prevent heart disease in obese people. However, according to the CNN article, they can also create cost-effective measures such as making patients try other drugs before this one.

However, list prices for the new drug remain unaffordable for many US families. According to CNN, this put patients in a situation where they had to make difficult choices between various options, as reported by The Associated Press.

Although the availability of the drugs is an issue, limiting its larger reach beyond the manufacturers, the FDA has been dealing with a drug shortage backlog for more than a year. Members of Novo Nordisk maintain that the company is increasing production and access, according to the AP.