Medicare can pay for obesity drugs like Wegovy in certain heart patients
Certain Medicare patients may get help paying for the popular weight-loss drug Wegovy, as long as they also have heart disease
Medicare can pay for the popular weight-loss drug Wegovy — as long as the patients using it also have heart disease and need to reduce the risk of future heart attacks, strokes and other serious problems, federal officials said Thursday.
The Centers for Medicare & Medicaid Services issued new guidance that says Medicare Part D drug benefit plans — which are offered through private insurers — could cover anti-obesity drugs that are approved for an additional use.
The move could pave the way for thousands of new prescriptions, resulting in billions of dollars in increased spending, analysts have said.
In practice, the guidance opens the door to wider coverage of Wegovy, the brand name of Novo Nordisk’s obesity medication semaglutide. The U.S. Food and Drug Administration this month approved a label change that allows Wegovy to be used to reduce the risk of cardiovascular events in people who are overweight or have obesity and also have existing heart disease.
Recent research showed that Wegovy cut the risk of heart attack, stroke and other problems by 20% versus a placebo, or dummy drug, in such patients. Cardiologists and other experts said use of semaglutide to reduce the risk of often fatal or disabling conditions could change the way heart patients are treated.
Wegovy carries a price tag of more than $1,300 a month, or $16,000 per year.
Part D plans could begin covering the drug “some time this year,” said Tricia Neuman, a Medicare policy specialist at KFF, a nonprofit that researches health policy.
“Medicare plans may be reluctant to move quickly to cover Wegovy given its relatively high
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