Expanded Coverage for Anti-Obesity Drugs in U.S. Government Health Programs

The Centers for Medicare and Medicaid Services (CMS) has issued guidance for Medicare Part D plans to cover anti-obesity medications for additional medical conditions, potentially widening access within U.S. government health programs. This coverage applies to drugs approved by the FDA for secondary indications, like reducing the risk of major cardiovascular events, but not for treating obesity alone. The change follows the FDA’s expansion of Wegovy’s label for cardiovascular event prevention, marking a significant policy shift. However, coverage for obesity as a standalone condition remains excluded, prompting ongoing congressional efforts to mandate it. Novo Nordisk and health policy experts view this as a positive step, albeit with anticipated prior authorization requirements to regulate usage strictly for the approved additional conditions. This adjustment allows for the inclusion of newly approved indications within existing contracts, with CMS highlighting the potential use of prior authorization to ensure appropriate drug use.

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[Source: Endpoints, March 21st, 2024]