Medicare to Cover Weight Loss Drug Wegovy for Heart Disease Patients

By Leira Aquino

Mar 21, 2024 10:01 PM EDT

Photo shows a semaglutide injectable. Wegovy, a popular weight loss drug by Novo Nordisk, will soon be covered by Medicare for its members with heart issues.
(Photo : JOEL SAGET/AFP via Getty Images)

Medicare will soon cover Wegovy, Novo Nordisk's popular weight loss drug, for its members who have been diagnosed with heart disease and are deemed at risk of cardiovascular problems. 

The Centers for Medicare & Medicaid Services (CMS) issued Thursday the decision, which marks a departure from Medicare's long standing policy of refraining from covering weight loss medications.

Coverage for Wegovy Can't Be Used Solely For Weight Loss 

CMS has released new guidelines that say Medicare Part D plans, which are run by private insurers and cover the costs of home medicine use, can now choose to cover anti-obesity drugs as long as they are used for medical reasons other than weight loss.  

"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," a spokesperson for CMS stated.

Such purposes include treating diabetes or mitigating cardiovascular risks among adults diagnosed with heart disease, obesity, or overweight conditions.

However, Medicare coverage for Wegovy will not extend to members intending to use the obesity drug solely for weight loss purposes. 

Instead, coverage will be reserved for individuals with heart disease seeking to prevent recurrent heart attacks and strokes.

As of March last year, approximately 51.5 million individuals were enrolled in Medicare Part D, according to data from the government.

READ NEXT: Novo Nordisk Now The 12th Most Valuable Company After Positive Weight Loss Pill Trial, Surpassing Tesla

Wegovy's FDA Approval

Wegovy recently received approval from the Food and Drug Administration (FDA), making it the first weight loss drug to gain approval from the agency for the additional purpose of preventing cardiovascular problems. 

"Wegovy is now the first weight loss medication to also be approved to help prevent life-threatening cardiovascular events in adults with cardiovascular disease and either obesity or overweight," John Sharretts, director of the Division of Diabetes, Lipid Disorders, and Obesity in the FDA's Center for Drug Evaluation and Research, said in a statement.

This comes after increasing efforts by lawmakers and drugmakers to push for the drug's accessibility as it was deemed to have promising results in lessening the risk of heart attacks, strokes, and other weight-related risks.

In a recent study involving 17,600 participants, which was cited by FDA, 20% reduction was found in the risk of major adverse cardiovascular events among individuals treated with Wegovy.

Without insurance, Wegovy can be bought at around $1,300 for a 28-day supply, according to GoodRX

READ MORE: Cigna to Expand Weight Loss Drug Insurance Coverage, Strikes Deals with Eli Lilly & Novo Nordisk

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