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Health Care



MEDICARE TO COVER OBESITY DRUGS, BUT NOT FOR WEIGHT LOSS

by Joseph Choi - 03/21/24 4:52 PM ET

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by Joseph Choi - 03/21/24 4:52 PM ET

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not for weight loss purposes the
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Medicare to cover obesity drugs - The Daily Debrief
The Hill's Headlines, May 28, 2024
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The Centers for Medicare and Medicaid Services (CMS) issued guidance allowing
for the coverage of anti-obesity medications, but only in cases they are
indicated for treating conditions other than obesity.

The CMS cited the recent expanded indication of the anti-obesity medication
Wegovy as having informed its decision. The Food and Drug Administration (FDA)
granted Wegovy approval earlier this month for reducing the risk of
cardiovascular death, heart attack and stroke in patients with cardiovascular
disease and obesity.



“With the recent change in the FDA approved use for Wegovy (semaglutide),
current Medicare Part D and Medicaid coverage rules apply,” a CMS spokesperson
said in a statement.

“CMS has issued guidance to Medicare Part D plans stating that anti-obesity
medications (AOMs) that receive FDA approval for an additional medically
accepted indication can be considered a Part D drug for that specific use,” the
spokesperson added, specifying that drugs that are FDA-approved for only weight
loss do not fall under this consideration.

Medicare has long been barred from covering weight loss treatments for
beneficiaries due to the Medicare Modernization Act of 2003. At the time, there
were concerns that the weight loss drugs on the market — specifically
fenfluramine/phentermine — carried dangerous side effects.

The Treat and Reduce Obesity Act introduced in Congress would allow for more
health care providers, services and drugs to be covered under Medicare. Obesity
medicine groups and drugmakers such as Novo Nordisk have heavily lobbied for the
bill to be passed.

Wegovy falls within the newer class of drugs known as GLP-1 agonists, which
mimic a hormone produced in the gut that stimulates insulin production and
suppresses appetite. In a multi-national study of 17,600 participants, Wegovy
was found to statistically reduce risk of a major adverse cardiovascular events
by 20 percent.

Tags CMS medicare Novo Nordisk wegovy

--------------------------------------------------------------------------------

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