Elevance, Kaiser, CVS Medicare plans will cover Wegovy in certain cases

Several major insurers will cover the weight-loss drug Wegovy for Medicare members with certain heart conditions, the Wall Street Journal reported March 28. 

Elevance Health, Kaiser Permanente and CVS Health told the outlet they will cover Wegovy when used to reduce the risk of heart attack and stroke for Medicare members with cardiovascular conditions. 

On March 8, the FDA approved Novo Nordisk's Wegovy to be used for preventing cardiovascular events in adults with cardiovascular disease who are also obese or overweight. The approval opened the door to broader coverage of the drug in Medicare. Federal law currently prohibits Medicare from paying for drugs to be used for weight loss only. 

CMS issued guidance that allowed Part D benefit plans to cover anti-obesity medications if approved for additional health benefits and used for those conditions. 

GLP-1 drugs can cost upwards of $15,000 dollars annually. Ozempic, Trulicity, Victoza and Mounjaro, are approved to treat Type 2 diabetes, though these drugs are prescribed off-label for weight loss. Wegovy and Saxenda are approved for weight loss.  

Some health plans and employers have pulled coverage of the drugs because of their high costs. 

Elevance Health told the Wall Street Journal it would cover the drug for preventing cardiovascular events for commercial and Medicare Part D plans in the coming weeks. It is also working with state's to determine Medicaid coverage guidelines for the drug. 

Kaiser Permanente said its Medicare Part D plans will cover Wegovy for plan members with heart disease effective immediately. CVS Health told the outlet its Medicare Advantage and Part D plans will cover Wegovy consistent with new guidance. 

Humana told the Wall Street Journal it is reviewing CMS' guidance, and UnitedHealth Group declined to comment to the outlet. 

Read more here. 





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