United States: According to the latest official report, the Medicare program will now cover Wegovy, the famous weight-loss drug, if the reason patients are taking it is to cure heart problems.
The decision has come after the US Food and Drug Administration (FDA) gave its approval to the famous medicine maker Novo Nordisk’s usage to provide cardiovascular benefits was added to the medicine’s label in the beginning of this month.
Benefits of the FDA decision
As an outcome of the US Centers for Medicare and Medicaid Services (CMS), the words that came from insurers reflected that Medicare Part D drug plans would provide insurance coverage for the medication if it is approved for another use.
CMS issued a statement and said, “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,” as US News reported.
More about the Medicare Part D plan
According to a Medicare policy specialist, Tricia Neuman at KFF – the Part D plans could begin covering the drug “some time this year.”
“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.
The cost of the Wegovy drug is not more than USD 1,300 per month.
Neuman also noted that even though the plans are established to allow the coverage, it would still be required to incur higher out-of-pocket fees, previously done authorizations, or step therapy, in which the patient should have tried a not-so-costly drug before the commencement of the novel treatment.
Wegovy and other weight-loss drugs
According to CNN Health reports, Wegovy is one of the four popular weight-loss medications known as GLP-1 receptor agonists.
Another two of them – Novo Nordisk’s Ozempic and Eli Lilly’s Mounjaro- have already been approved by the authorities for the treatment of those suffering from diabetes and are also more conducive to being covered by the insurers.
However, Wegovy and Eli Lilly’s Zepbound got the approval just for their weight-loss-functioning drugs. However, as done recently by the FDA, which also approved and expanded coverage for Wegovy’s heart benefits
It also means that there is less possibility of having insurance coverage.
It is because, by law, Medicare is not permitted to cover weight-loss drugs. However, currently, Congress is facing a dilemma of changing the existing law setting, as reported by CNN Health.
However, in the future, the FDA will give its approval for the medication in order to decrease the chances of heart attacks, strokes, and other heart-related problems; it will also be added to the Part D program for those dealing with heart diseases, as reported by CMS.