Medicare can provide coverage for weight loss medications when used to improve overall health benefits

Title: Medicare to Cover Weight Loss Drugs for Added Health Benefit

Medicare will now start covering certain weight loss drugs for the first time, but only if they are approved for an added health benefit, according to the Centers for Medicare and Medicaid Services. This new guidance opens the door for broader coverage of popular medications like Novo Nordisk’s Wegovy, which is now approved in the U.S. for heart health.

Under the new CMS guidance, Medicare Part D plans can cover obesity treatments that receive FDA approval for an additional health benefit. This means that Medicare patients with obesity and a history of heart disease can soon receive coverage for Wegovy to reduce their risk of heart attacks and strokes.

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The guidance also paves the way for future coverage of other weight loss medications, many of which are being tested for additional health conditions like fatty liver disease, chronic kidney disease, and sleep apnea. Drugmakers like Novo Nordisk and Eli Lilly are studying their weight loss medicines for these potential uses.

Wegovy, a GLP-1 medication that suppresses appetite and regulates blood sugar, is part of this trend towards expanded coverage for weight loss treatments. While approximately 50 million Americans have insurance coverage for weight loss drugs, many employers do not offer this benefit, according to a recent survey.

Legislation introduced by bipartisan lawmakers aims to eliminate a provision from a 2003 law that prevents Medicare Part D plans from covering drugs used for weight loss. In the meantime, Medicaid programs will be required to cover Wegovy specifically for its new cardiovascular use.

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Overall, these changes represent a significant shift in how weight loss medications are covered by insurance programs, offering hope for millions of Americans struggling with obesity.

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