Medicare Will Cover the Weight Loss Drug Wegovy to Reduce Heart Disease Risk
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Medicare will now cover Wegovy (semaglutide) for people who are overweight or have obesity and who have an increased risk of heart attacks, strokes, or other potentially life-threatening cardiovascular problems.
Weight loss drugs have long been excluded from Medicare coverage. But a spokesperson for the Centers for Medicare and Medicaid Services (CMS) said in an emailed statement that the U.S. Food and Drug Administration (FDA) decision earlier this month to approve Wegovy for the prevention of heart attacks and strokes prompted Medicare to add the medicine to its Part D prescription drug plans.
Other anti-obesity medicines still aren’t covered, and Wegovy coverage is still limited to people with heart disease who may benefit from weight loss.
“A drug that receives FDA approval for chronic weight management alone would not be considered a Part D drug,” the CMS spokesperson said. “If this same drug also receives FDA approval to treat diabetes or reduce the risk of major adverse cardiovascular events in adults with established cardiovascular disease and either obesity or overweight, then it would be considered a Part D drug for those specific uses only.”
Right now, Wegovy is the only FDA-approved weight loss drug that meets this standard.
Wegovy Offers Clear Survival Benefits
The clear survival benefits seen with Wegovy in this trial helped with its added FDA approval and Medicare coverage, says Melanie Jay, MD, an associate professor and the director of obesity research at the New York University Grossman School of Medicine in New York City.
“I think it has taken a long time for obesity to be fully recognized as a disease,” Dr. Jay says. “There is still a lot of obesity stigma and policymakers may still believe that developing obesity is the patient’s fault.”
On the other hand, there haven’t been many studies showing a survival benefit with weight loss drugs, Jay says.
“I think Medicare will only cover medications that have proven risk reduction, so I don’t see coverage expanding to, say, tirzepatide (Zepbound) just yet,” says Jody Dushay, MD, an endocrinologist at Beth Israel Deaconess Medical Center and an assistant professor at Harvard Medical School in Boston. The same goes for older weight loss pills like Qsymia (phentermine/topiramate) and Contrave (naltrexone/bupropion).
Beyond this, ongoing drug shortages may make it hard for Medicare patients who now qualify for Wegovy coverage to access the drug, especially at the lower starting doses people need to minimize side effects as they start treatment, Dr. Dushay says.
Wegovy Shortages Continue
“Right now there are deep and seemingly unending shortages of Wegovy at the starting doses,” Dushay says. “So, practically speaking, for the next several months I’m not sure how people will actually get this medication into their hands.”
Over the longer term, however, one upside of the Medicare decision to cover Wegovy is that private insurers that provide employee health benefits to millions of Americans may soon do the same, says Adam Gilden, MD, an associate professor at the University of Colorado School of Medicine and the associate director of the CU Weight Management and Wellness Clinic in Aurora.
“Typically private insurance follows the lead of Medicare,” Dr. Gilden says.
Muscle Loss Is a Concern for Older Adults Taking Wegovy
One concern that comes with more patients, especially older adults, on Wegovy is the potential for the drug to cause what’s known as sarcopenia, a gradual loss of muscle mass that typically occurs as people age. Rapid weight loss can cause sarcopenia at any age, but the concerns are heightened for older adults who are already at high risk and may become more prone to frailty, falls, and fractures as their muscle function declines.
“I think we always worry about the elderly developing sarcopenia, which is when muscle is replaced by fat,” says Shauna Levy, MD, an assistant professor at Tulane University School of Medicine and the medical director of the Tulane Weight Loss Center. “Wegovy can expedite this.”
But the benefits of Wegovy, especially for cardiovascular disease, outweigh the risks, Dr. Levy says. “Users of these medications should continue to perform exercise, especially resistance training, as much as possible in their schedule to minimize muscle loss.”
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