In a paradigm shift for Medicare coverage, the weight-loss medication Wegovy has now been approved for coverage for those with a one-two punch of obesity and heart disease. The announcement, stemming from a recent policy update by the Centers for Medicare and Medicaid Services (CMS), ushers in a new era where the government insurance program will shoulder the cost of the drug when prescribed to prevent heart attacks and strokes for high-risk patients.
Often wrestled with out-of-pocket expenses, seniors previously lacked Medicare support for obesity treatments, but with the Food and Drug Administration's recent expansion of Wegovy's approval, the tide is turning. According to the NPR report, the drug's expanded use is to reduce the risk of cardiovascular death, alongside heart attack and stroke in folks grappling with cardiovascular disease, coupled with overweight or obesity challenges.
Backing this policy update are clinical trials, which have shown that Wegovy essentially lowers the risks of cardiovascular events by a striking 20% in patients with a higher weight profile. This data, pivotal to the CMS's decision, adds another layer of protection for those previously left to fend for themselves in securing the costly treatment, with monthly injection prices skyrocketing above $1,000.
Even with the new guidelines in place, there's a catch: Medicare will not cover Wegovy for enrollees solely seeking weight loss. As per the San Antonio-based KENS 5 report, Dr. Alberto Chavez-Velazquez, an endocrinology and diabetes specialist emphasizes that "This is actually big news because, traditionally, Medicare has not had coverage or for weight loss. And it is important to make the distinction here that this is actually for patients with established cardiovascular disease."
Angela Fitch, president of the Obesity Medicine Association, weighed in, calling the update "a big step forward," while hoping that this spur might eventually expand to cover all overweight and obesity cases. Echoing this sentiment, the new policy's ripple effect aligns with the notion that where Medicare goes, other insurance providers may follow. "My hope would be that commercial insurance would follow," Fitch noted, according to the NPR interview.
The CMS is not turning a blind eye to emerging treatments either. The directive lays the groundwork for other anti-obesity medications to receive Medicare Part D coverage if they secure FDA approval for conditions beyond mere weight management. Novo Nordisk, the pharmaceutical company behind Wegovy, has acknowledged this development as "encouraging," ever hopeful for an even broader scope of coverage for obesity medicines as part of chronic weight management strategies.
