Although the program does not cover the drug for weight loss purposes, the decision could open up access and provide a potential path for future efforts.
The Centers for Medicare and Medicaid Services (CMS) has issued guidance for Medicare Part D plans run by private companies to cover obesity drugs to beneficiaries as long as they have an approved indication for a condition other than obesity. admitted that.
This follows the Food and Drug Administration’s (FDA) approval of the weight loss drug Wegovy to reduce the risk of serious adverse cardiovascular events such as heart attacks and strokes.
Wegovy is the first weight loss drug to be approved by the FDA for that purpose.
“CMS is committed to ensuring that people have access to treatments and treatment options that improve their health conditions. Due to changes in the use of the recently FDA-approved Wegovy (semaglutide), “Medicare Part D and Medicaid coverage rules apply,” a CMS spokesperson said in a statement.
The agency clarified that the review applies only to anti-obesity drugs indicated for “additional medically recognized indications” and not to drugs indicated solely for the treatment of obesity.
However, many obese patients may also have cardiovascular problems. The drug’s list price is about $1,200 per month.
“Part D coverage remains unavailable when AOM is used for chronic weight management in patients without additional medically recognized indications, unless provided as a supplemental benefit by a Part D plan.” the spokesperson added.
Remember: A 2003 bill legally prohibits Medicare from covering obesity treatment, but at the time the bill was passed due to concerns that the over-the-counter obesity drug Fen-Phen had dangerous side effects. was informed from.
The Obesity Treatment and Reduction Act, introduced in Congress and heavily lobbied by the pharmaceutical industry, would pave the way for Medicare to cover not only anti-obesity drugs but also counseling services.
