The Food and Drug Administration earlier this month cleared Ozempic manufacturer Novo Nordisk to market the weight-loss drug Wegovy for heart benefits. Medicare now will cover Wegovy prescriptions for patients with a high risk of heart disease. Both brands Ozempic and Wegovy are based on the anti-diabetic medication semaglutide. File Photo by Ida Marie Odgaard/EPA-EFE
March 21 (UPI) -- Medicare now will cover Wegovy after the Food and Drug Administration cleared the manufacturer to market the popular weight-loss drug as a treatment for heart problems.
A Centers for Medicare and Medicaid Services spokesperson told NBC News Thursday that Medicare, which historically has been barred from paying for weight-loss drugs, now will pay for Wegovy if it is being used to reduce the risk of heart disease. The drug still will not be covered if it is only being used for weight management.
The CMS said it reconsidered its coverage of Wegovy after the FDA expanded approval for the drug to be prescribed to people who are at risk of heart complications.
Anti-obesity drugs that get approval to treat conditions other than excess weight can be covered in Medicare Part D prescription plans. Reducing heart disease risk is a medically accepted use under federal law.
The FDA approved Wegovy manufacturer Novo Nordisk's application to list cardiovascular benefits earlier this month after reviewing a 17,000-patient study, which showed people who took Wegovy had a 20% lower risk of a cardiac event than people who took a placebo.
Lawrence Gostin, director of the O'Neill Institute for National and Global Health Law at Georgetown University, told NBC News that Medicare's coverage of Wegovy could be financially risky. The drug carries a list price of about $1,200.
The Congressional Budget Office on Wednesday maintained its view that coverage of Wegovy would increase overall federal spending, but the cost would depend on the actual use of the drug under eligible recipients and the duration of their treatment.
The Treat and Reduce Obesity Act, which would lift Medicare's restriction on coverage of weight-loss drugs, has bipartisan support, but it's unlikely to gain traction in Congress without clearer insight on how that would affect federal spending.
Wegovy is sure to be popular for Medicare patients, as a December survey from the University of Michigan National Poll on Healthy Aging found three in four adults think Medicare should cover prescription weight-loss drugs.
Novo Nordisk has said it is gradually increasing its supply of Wegovy over the course of this year to keep up with increased demand amid an ongoing shortage.
