Mar 21, 2024 - Health

Medicare allows coverage of weight-loss drugs for heart conditions

Close-up photo of a Wegovy box.

Photo: George Frey/Bloomberg via Getty Images

Medicare will allow coverage of new weight-loss drug Wegovy to reduce the risk of heart attack and stroke in enrollees.

Why it matters: Medicare bans coverage of drugs for weight loss, but more enrollees will have access to popular anti-obesity medications known as GLP-1 agonists as they are approved for more conditions.

Driving the news: The Food and Drug Administration earlier this month approved Novo Nordisk weight-loss drug Wegovy for cardiovascular risk, prompting Medicare to review its coverage policies.

  • The Centers for Medicare and Medicaid Services has advised plans administering Part D prescription drug benefits that they can cover weight-loss drugs for any additional FDA approval besides obesity.
  • That means the Medicare market for these drugs may continue to grow as pharmaceutical companies study their effects on kidney disease, sleep apnea and other conditions common in obesity.

Yes, but: While Medicare plans can now add Wegovy coverage for heart risks, many are unlikely to do so right away given its cost, we recently reported.

  • Wegovy is listed at around $1,300 per month, before rebates or discounts.
  • Many plans cover Ozempic, which has the same active ingredient as Wegovy, for diabetes.

Friction point: Drugmakers are lobbying Congress to lift the Medicare ban on covering drugs for weight loss.

  • Shares of Novo Nordisk and Eli Lilly, which makes competing products Mounjaro and Zepbound, dipped Wednesday after the Congressional Budget Office said government spending on the drugs would likely raise the deficit over 10 years, even after accounting for health benefits they provide.
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