Medicare to cover Wegovy for heart disease patients

March 22, 2024

Heart disease patients insured under the U.S. Medicare program will be covered for anti-obesity drugs, as long as the drugs have an approved indication for a condition beyond obesity. 

As first reported by WSJ, the Centers for Medicare and Medicaid Services (CMS) has issued updated guidance for Medicare Part D plans, following Novo Nordisk's recent expanded FDA approval.

Earlier this month, Novo announced that the FDA approved a label expansion for weight-loss drug Wegovy for the indication of reducing risks of major adverse cardiovascular events including cardiovascular death, non-fatal heart attack or non-fatal stroke, in adults with either overweight or obesity and established cardiovascular disease. 

So far, Wegovy is the only weight loss drug to receive an expanded FDA approval.

The change is a welcomed step forward for drugmakers like Novo Nordisk and Eli Lilly who have been pushing for expanded coverage from insurers. Medicare — under the Medicare Modernization Act, which passed in 2003 in the shadow of the Fen-Phen fallout — is prohibited from covering medications used for weight loss.

Lawmakers recently reintroduced the Treat and Reduce Obesity Act (TROA), an 11-year-old bipartisan piece of legislation which, among other improvements, would expand Medicare Part D coverage to include FDA-approved anti-obesity medications. The bill has been endorsed by a host of medical groups including the Obesity Medicine Association and, not surprising, pharma companies such as Boehringer Ingelheim, Novo Nordisk and Eli Lilly..