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Some Medicare recipients eligible for weight loss medication

Not everyone seeking weight loss medication to treat obesity will have the drug covered; only those at risk for adverse cardiovascular events.
Some Medicare recipients eligible for weight loss medication
Posted at 10:03 AM, Mar 22, 2024
and last updated 2024-03-22 12:03:10-04

Some Medicare Part D recipients will soon be eligible to have weight loss medication Wegovy covered by their plan, the agency said in a statement. 

Although Wegovy has become a popular tool for those battling obesity, not everyone on Medicare Part D plans will be eligible.

According to guidance provided by the Centers for Medicare and Medicaid Services, FDA-approved anti-obesity medications can be used for an additional medically accepted indication. The FDA said anti-obesity medications like Wegovy will be covered "to treat diabetes or reduce the risk of major adverse cardiovascular events in adults with established cardiovascular disease and either obesity or overweight."

Wegovy was approved for weight loss management by the Food and Drug Administration in 2021. Earlier this month, the FDA extended the drug's approval to "reduce the risk of cardiovascular death, heart attack and stroke in adults with cardiovascular disease and either obesity or overweight."

“Wegovy is now the first weight loss medication to also be approved to help prevent life-threatening cardiovascular events in adults with cardiovascular disease and either obesity or overweight,” said Dr. John Sharretts of the FDA’s Center for Drug Evaluation and Research. “This patient population has a higher risk of cardiovascular death, heart attack and stroke. Providing a treatment option that is proven to lower this cardiovascular risk is a major advance for public health.” 

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Other weight loss drugs could also become covered by Part D if the FDA approves them to reduce the risk of cardiovascular death. 

Medicare officials said weight loss drugs are not covered when used for chronic weight management in patients who do not have an additional medically accepted indication, like a history of heart disease. 

According to KFF, 50 million out of 65 million Medicare recipients are signed up for Part D coverage. 

Medications like Wegovy are known as GLP-1 agonists, and many of these drugs were initially prescribed to help manage Type 2 diabetes but have since gained popularity to help patients manage weight. 

According to the Cleveland Clinic, these medications help manage blood sugar levels by triggering insulin release from the pancreas. The drugs also help slow digestion, which causes less glucose to enter the bloodstream. The medicine also affects satiety, allowing patients to feel full after eating, the Cleveland Clinic said. 


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