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For the first time, Medicare plans can now cover a blockbuster weight loss drug, Wegovy. But the drug will be limited to people diagnosed with heart disease as well as weight problems. Still, NPR's Yuki Noguchi reports that this is a significant shift.
YUKI NOGUCHI, BYLINE: Wegovy is among the new class of obesity drugs promising a sea change in weight loss. GLP-1 agonists, as they are called, act on hormones and the brain to drastically reduce appetite, among other things. This month, the Food and Drug Administration also approved Wegovy to treat heart disease among overweight patients. In clinical trials, it said Wegovy reduced risks of cardiovascular events by 20%. That finding prompted the agency regulating Medicaid and Medicare to change the Medicare Part D drug policy to include Wegovy and require states to cover Wegovy for Medicaid patients with heart conditions. It said it could add similar medications as they are approved by the FDA, but the agency noted that it would do so only for those patients struggling with both weight and heart disease. In other words, the injections, which can cost well over a thousand dollars a month out of pocket, will not be covered for enrollees only seeking to lose weight. Obesity doctor Angela Fitch says that's still significant. She's president of the Obesity Medicine Association, a group that advocates for treatment.
ANGELA FITCH: It's certainly a big step forward, you know, compared to no coverage at all.
NOGUCHI: About a quarter of her patients are on Medicare. And, Fitch notes, Medicare sets the standard for coverage in insurance generally, so this could potentially lead to expanded benefits for still more patients.
FITCH: My hope would be that commercial coverage would follow.
NOGUCHI: Novo Nordisk, the maker of Wegovy, hailed the Medicare announcement and said it will continue lobbying for broader coverage of the drug, including to treat obesity alone. It is also among those pushing for Congress to expand coverage of obesity care and treatment under Medicare.
Yuki Noguchi, NPR News. Transcript provided by NPR, Copyright NPR.
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