Medicare paves way for weight loss drug coverage: WSJ

Less than two weeks after Novo Nordisk's weight loss drug Wegovy was approved to reduce the risk of heart attacks and strokes, CMS has issued guidance for Medicare coverage of weight loss drugs, The Wall Street Journal reported March 21. 

Per the guidance, Medicare Part D drug benefit plans may cover anti-obesity medications if they are approved for additional health benefits and used for those conditions, the agency told the news outlet. Medicare's prescription drug benefit currently excludes weight loss medications when solely used for weight loss.

The agency said it notified health plans on March 20 regarding the new guidance, which states that Wegovy can be covered for patients at increased risk of heart attack, stroke, or other serious heart conditions. It will not be covered if it's solely being used for weight loss. The same guidance applies for Medicaid coverage of the drug, according to NBC News. 

Many Part D plans already cover glucagon-like peptide-1 agonists such as Ozempic and Mounjaro for Type 2 diabetes. 

CMS' new guidance could open the door for broader coverage of weight loss drugs that are approved for additional health benefits aside from weight loss. The agency also said Part D plans are permitted to require prior authorization to ensure anti-obesity drugs are being used for a medically accepted purpose under federal law, according to the Journal.

On March 8, the FDA approved Wegovy for reducing the risk of cardiovascular death, heart attack and stroke in adults who have a history of heart disease and are either obese or overweight. The medication reduced major adverse cardiovascular events by 20% in a phase 3 trial of more than 17,000 obese and overweight adults.

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