Insurance Will Now Cover Popular Weight Loss Drugs for Some Patients

Wegovy, which is one of the recently mainstreamed type-2 diabetes medications that’s made headlines for its weight loss side effect, will now be covered by insurance plans in some cases.

Today the Wall Street Journal reported that CVS Health, Elevance Health, and Kaiser Permanente have announced their plans to cover Novo Nordisk’s semaglutide drug Wegovy under Medicare Part D prescription plans. The medication will be covered only for patients with heart conditions who are also overweight or obese—not solely for weight loss.

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Wegovy, which has the same active ingredient as the diabetes medication Ozempic, was previously approved to be prescribed for weight loss by the US Food and Drug Administration (FDA); however, Medicare was not permitted to approve coverage of a drug for weight loss under prior regulations. The drugs in this category tend to be prohibitively costly for most consumers, with price tags of more than $1,000 or more out-of-pocket for a month’s supply. Ozempic is approved for insurance coverage only for treating diabetes, though some doctors prescribe these drugs off-label for weight loss. (Several experts have urged caution against use of counterfeit semaglutide products promoted to yield this weight-loss effect, as some of these have reportedly caused hospitalization among some consumers.)

On March 8, 2024, the FDA had approved Wegovy for use by people with cardiovascular disease to reduce the risk of heart attack and stroke, opening the door to the Medicare approval process. A study cited by the FDA notice showed that treatment with Wegovy “significantly reduced the risk of major adverse cardiovascular events.”

Of the ruling, John Sharretts, MD, the director of the Division of Diabetes, Lipid Disorders, and Obesity in the FDA’s Center for Drug Evaluation and Research, said: “Wegovy is now the first weight loss medication also to be approved to help prevent life-threatening cardiovascular events in adults with cardiovascular disease and either obesity or overweight.” Dr. Sharretts added: “Providing a treatment option proven to lower this cardiovascular risk is a major advance for public health.”

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On March 22, the U.S. Centers for Medicare and Medicaid Services (CMS) announced that because of the FDA approval, it would move to cover the drug as part of the Medicare Part D plan. “CMS has issued guidance to Medicare Part D plans stating that anti-obesity medications that receive FDA approval for an additional medically accepted indication can be considered a Part D drug for that specific use,” said the message. This led to CVS Health, Elevance Health, and Kaiser Permanente announcing their plans for medication coverage.

Meanwhile, eyes are on other major insurance providers to examine their current stances. At press time, Humana stated that it is reviewing the coverage of Wegovy, while UnitedHealth has not yet commented on any pending coverage changes.

Actuarial specialists say that along with these approvals could come increased premiums for some Medicare add-ons, like Medicare Part D.

Also, pre-requisites for coverage of expensive medication could include trying different weight loss methods before coverage for the medication would be approved. 

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