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Wegovy’s newly verified heart benefits under review by Medicare

Wegovy’s newly verified heart benefits under review by Medicare
Packets of Wegovy at the Novo Nordisk A/S production facilities in Hillerod, Denmark, on 12 June 2023. (Photo: Carsten Snejbjerg / Bloomberg via Getty Images)

The US federal health insurance, Medicare may soon be required to cover the blockbuster weight-loss drug Wegovy for heart disease patients with obesity after regulators approved an expanded label last week.

The Centers for Medicare and Medicaid Services “is reviewing the FDA’s action to expand use of Wegovy to reduce the risk of cardiovascular death, heart attack and stroke in adults with cardiovascular disease and either obesity or overweight”, a spokesperson said in an email. The agency, known as CMS, will share additional information as appropriate, according to the spokesperson.

Medicare, the health insurance programme for the elderly and some people on long-term disability, doesn’t currently cover weight-loss drugs, which it puts in the same category as treatments for balding and erectile dysfunction. But after the US Food and Drug Administration said Wegovy could be used to help prevent life-threatening cardiovascular events, it raises the question of whether Medicare prescription drug programmes will now have to cover it for patients with a history of heart disease.

“Medicare will cover those drugs for the treatment of cardiovascular conditions among people with obesity” if the FDA were to expand the label, the Congressional Budget Office said in written responses to questions released last week following a hearing in late January. 

The CBO, which analyzes the economic impacts of proposed legislation, also said it was refining its projection of what other conditions are likely to be covered by Medicare and will share more information when available. 

“Regarding Medicaid coverage, states would be required to cover Wegovy for the purposes to prevent cardiovascular disease in people with obesity,” CMS said. About a third of state Medicaid programmes currently cover Wegovy, sold by Novo Nordisk A/S, and other GLP-1 drugs for weight loss.

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