Medicare can now cover Wegovy for more senior citizens – CNN

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Medicare could begin covering Wegoby for certain seniors and other beneficiaries with a history of heart disease after the U.S. Food and Drug Administration approved drugmaker Novo Nordisk’s application. Adds cardiovascular benefits on drug labels.

The Centers for Medicare and Medicaid Services said it notified insurers offering Medicare Part D drug plans that they may be able to cover the drug after the FDA expanded its approval this month.

“CMS has advised Medicare Part D plans that anti-obesity medications (AOMs) that are FDA-approved for additional medically recognized indications may be considered Part D drugs for that specific use. “We have issued guidance stating that this is possible,” CMS said in a statement.

Medicare is not allowed by law to cover medications for chronic weight management, but Congress is facing pressure to change that. However, if the same drug receives FDA approval to reduce the risk of heart attacks, strokes, and other serious adverse cardiovascular events, it will be added to Part D formulations for people who already have heart disease. The agency said there is a possibility that

According to CMS, insurers can use prior authorization, or prior approval, to ensure that Wegovy is used for medically recognized indications. The FDA approval applies to adults with cardiovascular disease who are obese or overweight.

The CMS guidance was first reported by the Wall Street Journal.

Wegovy is one of four very popular and very expensive drugs called GLP-1 receptor agonists. Two of them, Novo Nordisk’s Ozempic and Eli Lilly’s Munjaro, are approved to treat people with diabetes. These are more likely to be covered by Medicare Part D plans for people with diabetes or by private insurance companies.

However, Wegovy and Eli Lilly’s Zepbound were only approved as anti-obesity drugs until the FDA recently expanded Wegovy’s approval. As such, they were much less likely to be covered by insurance companies in commercial plans and only by a small number of state Medicaid programs.

CMS also said states must cover Wegobee in Medicaid plans to prevent cardiovascular disease in obese people, but will take steps to control its use, such as requiring patients to try other drugs or treatments first. He said there is a possibility of taking action.

Although drug companies offer small discounts on all four medications; high list price put them out of reach For many Americans. Wegovy’s price is $1,349 for his four weeks, while Zepound’s price is $1,060. Ozempic retails for $969 for a four-week supply, while Mounjaro costs $1,069.

The FDA’s approval was based on a study of 17,000 patients that showed people taking Wegovy had a 20% lower risk of cardiac events than those taking a placebo.

“Wegovy is the first weight-loss drug approved for use in the prevention of life-threatening cardiovascular events in adults with cardiovascular disease who are obese or overweight,” said Dr. One Dr. John Sharetz said: Obesity, the news release said.

A Congressional Budget Office analysis released Wednesday says coverage of WeGovy and similar drugs could reduce other health care spending, but the drugs likely would save the federal government at their current prices. It’s going to cost more than it costs. Some of the costs would be borne by Medicare enrollees through higher premiums and out-of-pocket costs.

CNN’s Meg Tyrrell contributed to this report.