Medicare to cover obesity drugs, but not for weight loss

The Centers for Medicare and Medicaid Services (CMS) has issued guidance allowing anti-obesity drugs, but only if they are indicated to treat conditions other than obesity.

CMS cited the recent expansion of indications for the anti-obesity drug Wegovy as influencing its decision. The Food and Drug Administration (FDA) granted Wegovy approval earlier this month to reduce the risk of cardiovascular death, heart attack, and stroke in patients with cardiovascular disease and obesity.

“Due to recent changes to the FDA-approved use of Wegovy (semaglutide), current Medicare Part D and Medicaid coverage rules apply,” a CMS spokesperson said in a statement.

“CMS has advised Medicare Part D plans that anti-obesity medications (AOMs) that have FDA approval for additional medically recognized indications can be considered Part D drugs for that specific use. The spokesperson added: Those approved by the FDA solely for weight loss purposes do not apply to this consideration.

Medicare has long been prohibited from covering weight loss treatments for beneficiaries under the Medicare Modernization Act of 2003. At the time, there were concerns that over-the-counter weight loss drugs, especially fenfluramine/phentermine, might have dangerous side effects.

The Obesity Treatment and Reduction Act introduced in Congress would allow more health care providers, services, and drugs to be covered by Medicare. Obesity medicine organizations and pharmaceutical companies such as Novo Nordisk are lobbying hard for the bill to pass.

Wegovy falls into a new class of drugs known as GLP-1 agonists, which mimic hormones produced in the intestine that stimulate insulin production and suppress appetite. In a multinational study of 17,600 participants, Wegovy was found to statistically reduce the risk of serious adverse cardiovascular events by 20%.