The Centers for Medicare and Medicaid Services (CMS) issued guidance allowing for the coverage of anti-obesity medications, but only in cases they are indicated for treating conditions other than obesity.
The CMS cited the recent expanded indication of the anti-obesity medication Wegovy as having informed its decision. The Food and Drug Administration (FDA) granted Wegovy approval earlier this month for reducing the risk of cardiovascular death, heart attack and stroke in patients with cardiovascular disease and obesity.
“With the recent change in the FDA approved use for Wegovy (semaglutide), current Medicare Part D and Medicaid coverage rules apply,” a CMS spokesperson said in a statement.
“CMS has issued guidance to Medicare Part D plans stating that anti-obesity medications (AOMs) that receive FDA approval for an additional medically accepted indication can be considered a Part D drug for that specific use,” the spokesperson added, specifying that drugs that are FDA-approved for only weight loss do not fall under this consideration.
Medicare has long been barred from covering weight loss treatments for beneficiaries due to the Medicare Modernization Act of 2003. At the time, there were concerns that the weight loss drugs on the market — specifically fenfluramine/phentermine — carried dangerous side effects.
The Treat and Reduce Obesity Act introduced in Congress would allow for more health care providers, services and drugs to be covered under Medicare. Obesity medicine groups and drugmakers such as Novo Nordisk have heavily lobbied for the bill to be passed.
Wegovy falls within the newer class of drugs known as GLP-1 agonists, which mimic a hormone produced in the gut that stimulates insulin production and suppresses appetite. In a multi-national study of 17,600 participants, Wegovy was found to statistically reduce risk of a major adverse cardiovascular events by 20 percent.