To tackle the growing obesity in the United States, it seems that it will start Medicare for weight loss. The Centers for Medicare and Medicaid Services announced that Medicare for weight loss drugs will be started if the medications are approved for an additional health benefit.
This decision about Medicare for weight loss drugs could mean that there might be coverage for popular weight loss medications like Novo Nordisk’s Wegovy, which recently received US approval for improving heart health.
Even though these weight loss drugs are expensive and have limited insurance coverage, there has been a rise in demand for these medications.
Medicare for Weight Loss
With the new CMS guidance, Medicare Part D plans can now cover obesity treatments that are FDA-approved for an extra health benefit. Currently, Medicare prescription drug plans (Part D) from private insurers do not cover these drugs that are being used only for weight loss.
This step to allow Medicare for weight loss drugs will allow coverage for Wegovy if the patients have obesity and a history of heart disease. Since Wegovy recently got approval from the FDA for the treatment to lower their risk of heart attacks and strokes, it is most probable the drug will also be covered in Medicare for weight loss drugs.
Additionally, Medicare for weight loss drugs will allow potential coverage of other weight loss medications, which are being researched for additional health issues.
Companies like Novo Nordisk, who are known for the diabetes drug Ozempic, and Eli Lilly, are carefully looking for more weight loss medications that can help in treating fatty liver disease, chronic kidney disease, sleep apnea, and other conditions.
For these drugs to fall under Medicare for weight loss medication, they need to show positive results in late-stage trials and then seek FDA approval for those specific uses.
Need for Medicare for Weight Loss Drugs
About 110 million adults in the U.S. have obesity, and roughly 50 million of them have insurance that covers weight loss medications, according to a Novo Nordisk spokesperson.
Some of the biggest insurers in the country, like CVS Health’s Aetna, also offer coverage for these treatments.
However, many employers do not offer coverage. According to an October survey by the International Foundation of Employee Benefit Plans (IFEBP), only 27% of over 200 companies covered GLP-1s for weight loss, compared to 76% that covered these drugs for diabetes.
However, 13% of employers said they were considering adding coverage for weight loss treatments.
A rule from a 2003 law states that Medicare Part D plans cannot cover drugs used specifically for weight loss. However, Medicare does cover services such as obesity screening, counseling, and bariatric surgery.
Some bipartisan lawmakers have introduced a bill to remove this rule, but its future is yet to be decided in Congress.
A spokesperson from CMS mentioned last week that Medicaid programs are becoming necessary to cover Wegovy for its new use in treating cardiovascular conditions.
Medicaid is required by law to cover almost all FDA-approved medications, but weight loss treatments are among the few types of drugs that can be left out of coverage. Currently, about 1 in 5 state Medicaid programs cover GLP-1 drugs for weight loss.
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