The Centers for Medicare and Medicaid Services (CMS) has announced a new policy regarding coverage for anti-obesity medications (AOMs), but with specific limitations. Under the revised guidance, Medicare will cover these drugs only when they are prescribed for conditions other than obesity itself.
This decision follows the recent expansion of Wegovy’s approval by the Food and Drug Administration (FDA). Earlier this month, the FDA granted Wegovy approval for reducing the risk of cardiovascular events such as death, heart attack, and stroke in patients suffering from both cardiovascular disease and obesity.
“Given the recent expansion of Wegovy’s approved uses, we are adhering to existing Medicare Part D and Medicaid coverage guidelines,” a CMS spokesperson said. “Anti-obesity medications that receive FDA approval for additional medically accepted indications can now be considered under Part D coverage for those specific uses. However, drugs approved solely for weight loss will not be covered.”
Historically, Medicare has excluded coverage for weight loss treatments due to concerns about the safety of earlier drugs, notably fenfluramine/phentermine, which were associated with significant side effects.
Legislative efforts are underway to expand Medicare coverage for obesity-related treatments. The Treat and Reduce Obesity Act, recently introduced in Congress, aims to broaden the scope of covered healthcare providers, services, and medications. Advocates, including obesity medicine organizations and drug manufacturers such as Novo Nordisk, are actively lobbying for the passage of this bill.
Wegovy, a member of the newer class of drugs known as GLP-1 agonists, works by mimicking a gut hormone that enhances insulin production and reduces appetite. In a large-scale international study involving 17,600 participants, Wegovy demonstrated a 20 percent reduction in the risk of major adverse cardiovascular events.
