Medicare May Undergo HUGE Coverage Change

After Novo Nordisk revised the prescription advertising for Wegovy to include the claim that it decreases cardiovascular risks in addition to its anti-obesity effects, the medicine may soon be covered by Medicare.

Because it was administered as a therapy for obesity, which is not allowed under current Medicare coverage standards, the medicine was previously not covered.  It is now stated on the drug’s new label that it may be used to lower the risk of heart disease.

According to CMS (Centers for Medicare and Medicaid Services), almost 40% of Medicare beneficiaries suffer from some kind of cardiac problem. 

Weight reduction medicines like Wegovy must be prescribed for diabetes to be covered by Medicare. Once CMS decides how to cover Wegovy under this amended prescription categorization, the FDA will make the decision regarding cardiovascular diseases.

Medicare Part D plans might advertise the prescription coverage to Medicare beneficiaries if permitted, but it’s unlikely that plans would alter to cover the drug until 2025.

The cost is the main argument against Wegovy’s coverage by Medicare. A huge portion of the population may be eligible for the treatment, but Medicare might end up paying a big sum due to the drug’s high cost, which averages $1,300 for a month’s supply. Some are concerned that the medications might lead to unsustainable weight reduction if taken excessively.

Semaglutide, sold under the trade name Wegovy, is the same active ingredient of Ozempic, a medication used to treat type 2 diabetes.  Some physicians have been prescribing it off-label for weight reduction purposes. Novo Nordisk, maker of both drugs, states that they are not interchangeable.

According to DrugWatch, Gastroparesis, allergic reactions, visual abnormalities, pancreatitis, and the possibility of thyroid C-cell tumors are among the severe adverse effects that might occur as a result of using Ozempic. The Food and Drug Administration (FDA) informed the public in a safety statement on January 11, 2024, that they have not identified any evidence linking Ozempic or Wegovy to thoughts of suicide.

Diarrhea, nausea, vomiting, headache, and lethargy are some of the adverse effects associated with Wegovy. In addition, thyroid cancers and low blood sugar have been found in certain individuals. The danger of adverse effects is constant with any weight loss medication.

Future obesity drugs that reduce the risk of heart attacks may seek the same FDA clearance and Medicare coverage if their effects are comparable.