The Wall Street Journal reported on March 28, 2024, that some health insurance carriers, CVS Health, Elevance Health, and Kaiser Permanente, would extend coverage in their Medicare plans for Wegovy if it is prescribed to reduce the risk of heart attacks or strokes for people with cardiovascular disease.
Many insurers in the employer health care plan market, and self-funded employer plans have resisted covering Wegovy and other GLP-1 drugs for weight loss. They have been concerned about the high costs of the drugs (approximately $1,000/month) and that they may be needed indefinitely to maintain the weight loss and the relatively short history with their efficacy and concern about potential long-term side effects.
A recent decision of the FDA approved the use of Wegovy as a preventive measure for heart attacks and strokes for individuals with cardiovascular disease and either obesity or overweight. The FDA determined that it was effective at reducing the risks sufficiently to approve its use for that purpose.
Since it is now approved for that use, the insurers noted above have determined that it will be covered by the Medicare plans they administer but it has not yet been expanded to commercial plans. However, the tide seems to be turning in that direction, and if the United States Preventive Care Task Force (USPCTF) approves the use as well with either an “A” or “B” rating, the ACA rules will make its availability mandatory (in the appropriate instances) for plans to cover as a preventive medication with no out of pocket costs to the insured.* See the World discussion on the pros and cons here, and you can listen to a replay of our recent webinar on weight loss medications here.