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 loss drugs for the primary time – so long as they’re approved for an added health benefit, the Centers for Medicare and Medicaid Services said Thursday.
That opens up the door for broader coverage of some highly popular weight loss medications resembling Novo Nordisk‘s Wegovy, which is now approved within the U.S. for heart health. Those treatments have skyrocketed in demand during the last 12 months despite their hefty price tags and spotty insurance coverage.
Under a recent CMS guidance, Medicare Part D plans can cover obesity treatments that receive Food and Drug Administration approval for a further health benefit. Medicare prescription drug plans administered by private insurers, generally known as Part D, currently cannot cover those drugs for weight loss 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.
However the guidance will even open the door to future coverage of other weight loss medications, lots of that are being tested for additional health conditions.
Drugmakers resembling Novo Nordisk, which also makes the diabetes drug Ozempic, and Eli Lilly are studying their weight loss medicines as treatments for fatty liver disease, chronic kidney disease, sleep apnea and more. Those drugs would wish to return late-stage trial results after which be submitted for FDA approval for those uses.
Wegovy is a component of a category of drugs 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 loss is a mixed bag.
Roughly 110 million American adults live with obesity and roughly 50 million of them have insurance coverage for weight loss drugs, a spokesperson for Novo Nordisk said in an announcement last week.
A number of the nation’s largest insurers, resembling CVS Health’s Aetna, also cover the treatments.
But many employers don’t. An October survey of greater than 200 corporations by the International Foundation of Worker Benefit Plans, or IFEBP, found only 27% provided coverage for GLP-1s for weight loss, compared with the 76% that covered those drugs for diabetes. Notably, 13% of employers indicated they were considering coverage for weight loss.
A provision of a 2003 law established that Medicare Part D plans can’t cover drugs used for weight loss, but this system does cover obesity screening, behavioral counseling and bariatric surgery. A gaggle of bipartisan lawmakers have introduced laws that might eliminate the supply, 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 recent cardiovascular use. By law, Medicaid must cover nearly all FDA-approved medications, but weight loss treatments are amongst a small group of drugs that can be excluded from coverage. Around one in five state Medicaid programs currently cover GLP-1 drugs for weight loss.