Medicare To Cover Weight Loss Drug to Reduce Risk of Cardiovascular Disease

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On March 21, 2024, the Centers for Medicare and Medicaid Services (CMS) announced that Wegovy, a prescription weight loss medication developed by Novo Nordisk, would now be eligible for coverage under Medicare Part-D for the specific use of reducing the risk of death attributable to cardiovascular disease in overweight or obese individuals. Medicare currently is not permitted by law to cover drugs used solely for chronic weight management, although Medicare may cover a drug that is used for weight loss if it also receives U.S. Food and Drug Administration (FDA) approval for another medically accepted use, like treating cardiovascular disease.

CMS’ approval of coverage for Wegovy comes less than 2 weeks after the FDA announced that it would approve Wegovy for the preventative treatment of cardiovascular disease in those who are obese or overweight. The FDA’s approval was based on an international, multiyear study of 17,000 overweight or obese patients, with results showing that those individuals taking Wegovy had a 20% lower risk of an adverse cardiac event, such as heart attack or stroke, than those taking a placebo. Despite a current supply shortage, the demand for Wegovy has never been higher, even with the average current cost of the drug exceeding $1,000 per month. The continuous surge in demand can likely be attributed to America’s ongoing obesity crisis. According to the latest statistics, it is estimated that nearly half of all adults in the U.S. have some form of cardiovascular disease, while 73.1% of all U.S. adults are considered overweight or obese. Even with the “limited scope” of coverage approval by CMS, most private insurers have indicated a reluctance to follow suit.

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For more information, contact:
Isabelle Bibet-Kalinyak, Vice Chair | 973.403.3131 | ibibetkalinyak@bracheichler.com
Michael C. Foster | 973.403.3102 | mfoster@bracheichler.com

*This is intended to provide general information, not legal advice. Please contact the authors if you need specific advice.

Related Practices:   Healthcare Law

Related Industry:   Healthcare