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According to this recent article on cbs42.com, Medicare is expand drug coverage to cover drugs that treat conditions related to obesity, but not drugs used for weight loss purposes:  The Centers for Medicare and Medicaid (CMS) has issued new guidance regarding the coverage of anti-obesity medications. However, there’s a catch: these medications will be covered only when they are indicated for treating conditions other than obesity itself. Specifically, the recent expanded indication of the anti-obesity medication Wegovy (semaglutide) informed CMS’s decision. Wegovy recently received FDA approval for reducing the risk of cardiovascular death, heart attack, and stroke in patients with both cardiovascular disease and obesity. As a result, Medicare Part D and Medicaid coverage rules now apply to Wegovy based on its updated use. It’s important to note that Medicare has historically been prohibited from covering weight loss treatments due to the Medicare Modernization Act of 2003. Back then, concerns about dangerous side effects associated with weight loss drugs, such as fenfluramine/phentermine, led to this restriction. The Treat and Reduce Obesity Act, currently introduced in Congress, aims to expand coverage under Medicare for health care providers, services, and drugs related to obesity treatment. Advocates, including obesity medicine groups and drugmakers like Novo Nordisk, have been lobbying for the bill’s passage. Wegovy belongs to a newer class of drugs known as GLP-1 agonists, which mimic a gut hormone to stimulate insulin production and suppress appetite. In a multi-national study, Wegovy was found to statistically reduce the risk of major adverse cardiovascular events by 20 percent. If you have any questions about what your Medicare plan will or will not cover, contact Ted Czabanowski for assistance. |
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