Several leading insurers have agreed to start paying for the popular weight loss drug Wegovy for Medicare recipients with certain heart conditions. However, coverage will not include use for weight loss alone.
CVS Health’s Aetna, Elevance Health and Kaiser Permanente will pay for Wegovy to reduce heart attack risk in patients with cardiovascular conditions who meet certain body weight criteria and are enrolled in Medicare drug coverage. Elevance, which operates many Blue Cross and Blue Shield health plans, said it also will extend coverage to patients insured by a commercial plan.
CMS has issued guidance to Medicare Part D plans to cover obesity drugs if they secure approval for additional medically accepted uses, The Wall Street Journal reported. The Centers for Medicare & Medicaid Services said the guidance will apply to Wegovy from Novo Nordisk, which the FDA recently approved to reduce risk of stroke or heart attack in people with cardiovascular disease and a body mass index above a certain threshold. A study showed Wegovy reduced cardiovascular risk by about 20% vs. a placebo.
This coverage will ease the financial burden on patients who had been paying more than $1,000 out of pocket each month because their health plan wouldn’t cover the medication. However, the broader coverage could result in billions of dollars in additional drug spending by health insurers that have struggled to keep a lid on rising health costs.
Participating insurers plan to begin covering the drug immediately or in coming weeks:
- CarelonRx will begin coverage in April and is working with state government agencies to determine Medicaid coverage of Wegovy
- Kaiser Permanente said its Medicare Part D plans will cover Wegovy immediately for plan members with heart disease but not for patients using it for weight loss alone.
- CVS Health said Part D and Medicare Advantage plans offered by its Aetna insurance unit will provide Part D coverage of Wegovy consistent with the new CMS guidance.
- Humana said it is reviewing the CMS guidance.
- UnitedHealth Group declined to comment to the Journal.
“It’s a very exciting time,” said Dr. Shauna Levy, an obesity medicine specialist and medical director of the Tulane Bariatric Center. “Anything that improves access is a victory for us. This is also hopefully setting a precedent for private insurers to follow suit.”