More Senior Folks Can Now Receive Medicare Coverage For Wegovy

Based on the fact that the United States Food and Drug Administration has given its approval to the application submitted by the pharmaceutical company Novo Nordisk to include cardiovascular benefits on the label of the prescription, Medicare may begin to cover Wegovy for some senior citizens and other beneficiaries who have a history of heart disease. After the Food and Drug Administration (FDA) widened the permission this month, the Centers for Medicare and Medicaid Services (CMS) stated that it had advised insurers who supply Medicare Part D drug plans as to whether or not they could cover the medication.

Legally speaking, Medicare is not permitted to fund medications for the treatment of chronic weight, despite the fact that Congress is under pressure to amend this provision. Nevertheless, the Food and Drug Administration (FDA) has stated that if the same drug is also approved to reduce the risk of heart attacks, strokes, and other significant adverse cardiovascular events, then it may be included in the Part D formularies for individuals who have already been diagnosed with heart disease.

The Centers for Medicare and Medicaid Services (CMS) stated that insurers may employ prior permission, also known as advance approval, to guarantee that Wegovy is being used for a medically acceptable use. This approval from the FDA is applicable to persons who suffer from cardiovascular disease and who are either overweight or obese on average.

The instruction from the CMS was initially reported by the Wall Street Journal. GLP-1 receptor agonists are a class of four drugs that are extremely popular and extremely expensive. Wegovy is one of these treatments. Two of these, namely Mounjaro by Eli Lilly and Ozempic by Novo Nordisk, have been given the green light to be used in the treatment of diabetic patients. Plans that fall under Medicare Part D and commercial insurers for diabetic people are more likely to cover them than other types of insurance.

However, prior to the FDA’s recent decision to increase Wegovy’s clearance, both Wegovy and Zepbound, which is manufactured by Eli Lilly, were exclusively approved as anti-obesity medications. As a result, they have a far lower probability of being covered by insurers operating under commercial plans, and they were only covered by a few state Medicaid programs.

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