The Centers for Medicare and Medicaid Services told multiple media outlets that Medicare Part D plans could cover anti-obesity drugs like Wegovy.
BothThe Wall Street Journal and Endpoints News reported Thursday that an agency spokesperson said CMS issued a guidance to Medicare Part D plans — which are administered by private insurers — stipulating that these medications with approval from the Food and Drug Administration to reduce the risk of major cardiovascular events can be covered for that use.
Endpoints News noted that the move “could meaningfully” expand access to the drugs for patients receiving their healthcare coverage through the federal government who also have a history of heart disease and are using anti-obesity medications to prevent recurring heart attacks or strokes.
The announcement comes one week after the FDA approved a label expansion for Novo Nordisk’s popular GLP-1 Wegovy to be used as a treatment in heart disease.
The decision caused many in the industry to speculate about whether CMS would increase coverage of the drug, its sibling drug Ozempic and potentially its rivals, Eli Lilly’s Mounjaro and Zepbound — assuming the latter three receive an expanded label indication.
The four GLP-1 drugs have achieved widespread popularity for weight loss, thanks largely to celebrity- and social media-driven off-label use that has resulted in a boon for Novo and Lilly’s respective bottom line but also led to a series of supply shortages.
However, beyond the weight loss capabilities, studies released in recent months have delved into whether this class of drugs could have greater use in other disease states.
In August, Novo announced that its once-weekly semaglutide 2.4 mg treatment — better known by the brand name Wegovy — cut the risk of major adverse cardiovascular events (MACE) by 20% in a clinical trial.
A few months later, Novo released additional data that Wegovy cut the MACE risk by 20% in adults with established cardiovascular disease who were overweight or had obesity but did not have diabetes. The drug also met secondary endpoints in terms of lowering patients’ blood pressure, cholesterol and blood sugar.
With the research data in hand, the drugmaker submitted Wegovy to regulatory bodies in the U.S. and the E.U. to expand its label indication.
CMS told The Journal that it notified plans on Wednesday about its decision.
For a March 2024 article on sider payer coverage possibly giving the GLP-1 revolution a jolt, click here.
