Under new CMS guidance, Medicare Part D plans can cover Food and Drug Administration-approved obesity treatments as an additional health benefit. Medicare prescription drug plans run by private insurance companies (known as Part D) currently cannot cover these drugs solely for weight loss purposes.
The agency’s guidance means Medicare patients will soon be able to receive Wegobee coverage as long as they have a history of obesity and heart disease and are prescribed treatments that reduce their risk of heart attack or stroke. There is. Earlier this month, the Food and Drug Administration approved his Wegovy for that purpose.
This guidance also opens the door to future applications of other weight loss drugs, many of which are being tested for additional health conditions.
Pharmaceutical companies such as Novo Nordisk, which also makes the diabetes drug Ozempic, Eli Lilly and Eli Lilly are researching weight loss drugs as treatments for fatty liver disease, chronic kidney disease, sleep apnea, and more. To be eligible, these drugs must submit late-stage trial results and then apply for FDA approval for their use.
Wegovy is a type of drug called GLP-1, which mimics hormones produced in the intestines to suppress appetite and help regulate blood sugar levels. Coverage for these treatments when used for weight loss purposes varies.
A Novo Nordisk spokesperson said in a statement last week that about 110 million U.S. adults are obese, and about 50 million of them have insurance coverage for weight-loss drugs.
The nation’s largest insurance companies, including CVS Health’s Aetna, also cover the treatment.
But many employers don’t. October investigation In a survey of more than 200 companies conducted by the International Foundation for Employee Benefit Plans (IFEBP), 76% covered GLP-1 for diabetes treatment, while 76% covered GLP-1 for weight loss. Only 27% of companies provided insurance. Specifically, 13% of employers said they would consider compensation for weight loss.
provisions of 2003 Act It turns out that while Medicare Part D plans don’t cover drugs used for weight loss, the program does cover obesity screening, behavioral counseling, and bariatric surgery.introduced by a bipartisan group of lawmakers. law That would repeal the provision, but its fate in Congress is by no means certain.
A CMS spokesperson told CNBC last week that the Medicaid program will be required to specifically cover Wegobee for new cardiovascular uses.by law, Medicaid must cover nearly all FDA-approved drugs, but weight loss treatments are one of the few drugs that can be excluded from coverage.Approximately one in five states’ Medicaid programs currently covering GLP-1 drugs for weight loss.
