Policy and Legal

Three of the country’s largest health insurers will soon begin paying for a top weight-loss drug for certain people on Medicare with heart-related conditions, The Wall Street Journal (subscription) reports.

What’s going on: “CVS Health, Elevance Health and Kaiser Permanente said they would cover Novo Nordisk’s Wegovy for the use of reducing the risk of heart attacks and strokes in people who have cardiovascular disease, meet body-weight criteria and are covered by a Medicare drug-benefit plan.”

• The class of weight loss drugs to which Wegovy belongs was previously excluded from Medicare coverage by a U.S. law.

Why it’s important: “The decisions will ease the financial burden” of those who have been paying out of pocket for Wegovy and are likely to spur use of the drug among those who couldn’t afford or did not want to pay the full price.

• Approximately two-thirds of U.S. adults are overweight or obese, according to the recent NAM report, “Manufacturers on the Front Lines of Communities: A Deep Commitment to Health Care.”
• Excess body weight and obesity are associated with higher health-care costs for both employers and their workers. They also “raise the likelihood of other illnesses” and affect “productivity and the ability to complete job functions,” according to the study, which points to weight-loss drugs as part of the solution.

Why it happened: New guidance released last week by the Centers for Medicare and Medicaid Services holds that Medicare Part D plans, administered by private insurance companies, could “cover anti-obesity medications if the drugs receive approval for an additional use that is considered medically accepted.”

• This applies to Wegovy, which the Food and Drug Administration recently approved for reducing the risk of heart attacks and strokes among those with histories of heart disease and body mass indices above a certain threshold.

However … The use of Wegovy “for weight loss alone” will remain excluded from coverage under the CMS guidance.