 Health Care |
Health Care |
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Medicare plans can cover Wegovy for heart issues |
Medicare plans can now cover Wegovy for patients who have an increased risk of cardiovascular problems, officials said Thursday. |
While the program won't cover the drug for weight loss, the decision could still open access and provide a potential pathway for future efforts.
The Centers for Medicare and Medicaid Services (CMS) issued guidance for Medicare Part D plans — administered by private companies — allowing obesity drugs to be covered for beneficiaries as long as they have an approved indication for a condition other than obesity.
This comes on the heels of the Food and Drug Administration (FDA) approving the weight-loss medication Wegovy for reducing the risk of major adverse cardiovascular events like heart attack and stroke.
Wegovy is the first weight loss drug to receive FDA approval for that purpose.
"CMS is committed to ensuring that people have access to treatments and treatment options that improve health outcomes. With the recent change in the FDA approved use for Wegovy (semaglutide), current Medicare Part D and Medicaid coverage rules apply," a CMS spokesperson said in a statement.
The agency made it clear that this consideration would only apply to anti-obesity medications indicated for "an additional medically accepted indication," and not for drugs solely indicated for treating obesity.
However, many patients with obesity also likely have cardiovascular issues. The drug carries a list price of around $1,200 a month,
"Part D coverage is still not available for AOMs when used for chronic weight management in patients who do not have the additional medically accepted indication, unless provided as a supplemental benefit by the Part D plan," the spokesperson added.
Remember: Medicare is legally barred from covering obesity treatments due to a 2003 bill, which was informed at the time by concerns that obesity drugs on the market — fen-phen — carried dangerous side effects.
The Treat and Reduce Obesity Act, introduced in Congress and heavily lobbied for by the pharmaceutical industry, would clear the way for Medicare to not only cover anti-obesity medications but also counseling services. |
Welcome to The Hill's Health Care newsletter, we're Nathaniel Weixel and Joseph Choi — every week we follow the latest moves on how Washington impacts your health. |
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How policy will be impacting the health care sector this week and beyond: |
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Senate Democrats argued Wednesday that restrictions on in-vitro fertilization (IVF) are the first in what will be a wave of unexpected barriers to women's reproductive health access resulting from the overturning of Roe v. Wade. Senate Republicans said they’ve done the work to protect IVF access. The hearing was the third on the topic of abortion since the Supreme Court’s Dobbs v. Jackson Women's Health Organization … |
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| U.S. life expectancy in 2022 was 77.5 years, according to new federal data, going up by 1.1 years and marking the first time the metric has risen since 2019. From 2019 to 2021, the U.S. mortality rate fell by 2.4 years. This trend was attributed to several factors, including the COVID-19 pandemic and record overdoses rates. But the country now appears to be on the rebound. A total of 3,279,857 resident deaths were recorded … |
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A pair of senators introduced a bill Wednesday that would require the State Department to track xylazine in its annual report. |
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Branch out with a different read: |
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Republican majorities block efforts to expand Medicaid in Georgia and Kansas |
ATLANTA (AP) — Plans to expand Medicaid coverage to over half a million more people in Georgia and Kansas were defeated by Republican-led committees in the states’ legislatures Thursday. There are currently only 10 states that don't cover people with incomes up to 138% of the federal poverty line, after North Carolina began offering … | |
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Local and state headlines on health care: |
- McKee names Cory King as state health insurance commissioner (Rhode Island Current)
- This in-school clinic serves students' mental, physical health needs — with hopes to reduce school absences (Deseret News)
- GOP-led Kansas House passes budget, repeatedly circling back to dire health of rural hospitals (Kansas Reflector)
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Health news we've flagged from other outlets: |
- Dozens sue saying Ozempic, other weight loss and diabetes drugs cause harmful side effects (USA Today)
- Women are getting off birth control amid misinformation explosion (The Washington Post)
- Native Americans are hardest hit by syphilis surge (NPR)
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Most read stories on The Hill right now: |
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The New York attorney general’s office has filed judgments in Westchester County, where former President Trump’s golf resort and private … Read more |
| Social Security Administration (SSA) Commissioner Martin O'Malley warned that raising the retirement age for the program would disproportionately hurt … Read more |
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Opinions related to health submitted to The Hill: |
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You're all caught up. See you tomorrow! |
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