Understanding Medicare Coverage for Heart Disease Prevention with Wegovy
In a groundbreaking move, Medicare Part D will now cover the use of Wegovy, a new weight-loss drug, as a treatment for preventing heart attacks and strokes. The Centers for Medicare and Medicaid Services (CMS) recently issued a policy stating that Medicare and Medicaid plans can cover Wegovy when it is prescribed for this purpose. This is a significant development as Medicare has not previously covered weight-loss treatments, leaving seniors to pay out of pocket or rely on supplemental insurance.
Wegovy belongs to a class of obesity drugs known as GLP-1 agonists, which work by reducing appetite through hormonal and brain mechanisms. Clinical trials have shown that Wegovy can reduce cardiovascular events by 20% in individuals with higher weights. With the recent expansion of Wegovy’s approval by the Food and Drug Administration, it can now be used to reduce the risk of cardiovascular death, heart attack, and stroke in people with cardiovascular disease who are overweight or obese.
Under the new Medicare Part D drug program guidance, coverage for Wegovy is limited to patients with both heart disease and excess weight. Those seeking coverage solely for weight loss purposes will not be eligible for Medicare coverage of the drug, which can cost up to $1,000 per month. However, this move still marks a significant step forward in terms of coverage for obesity treatments.
The impact of this Medicare coverage extends beyond just the eligible patients. Medicare sets the standard for insurance coverage, and it is hoped that commercial insurance will follow suit. Angela Fitch, president of the Obesity Medicine Association, sees this as a positive development and believes that it could lead to expanded coverage for all individuals who are overweight or obese. While coverage for obesity treatments still has a long way to go, this step by Medicare is seen as a move in the right direction.
The CMS spokesperson emphasized their commitment to improving health outcomes and ensuring that people have access to treatments that can make a difference. This means that the guidance for Medicare coverage may also extend to other similar drugs in the future. Anti-obesity drugs that are FDA-approved for specific conditions, not just weight loss, may be considered for coverage under Medicare Part D plans. If these drugs receive FDA approval for treating diabetes or preventing cardiovascular disease, they could potentially be covered by Medicare Part D.
However, CMS also notes that prior authorizations may be required to ensure that these drugs are being used only for approved purposes. This is to prevent misuse or off-label use of the drugs. While Novo Nordisk, the maker of Wegovy, is encouraged by the new guidance from CMS, they hope that Part D coverage can be expanded to include “obesity medicines used for chronic weight management.” The drug maker believes that Congress should take steps to expand coverage for obesity treatment.
Overall, the inclusion of Wegovy in Medicare Part D coverage for heart disease prevention is a significant development. It represents a step forward in recognizing the importance of addressing obesity as a risk factor for cardiovascular disease. While coverage is currently limited to patients with both heart disease and excess weight, there is hope that this will pave the way for expanded coverage in the future. The impact of Medicare’s decision could extend beyond just Medicare beneficiaries, as commercial insurance may also follow suit. With continued advocacy and support, it is possible that more individuals struggling with obesity will have access to the treatments they need for better health outcomes.