Wegovy® Coverage with the New Cardiovascular Indication
On March 8, 2024, the Food and Drug Administration (FDA) approved a new indication for the use of Wegovy® (semaglutide) injections to reduce the risk of cardiovascular death, heart attack, and stroke in adults who have cardiovascular disease and are either obese or overweight. The new indication and increased demand for GLP-1 drugs have led to ongoing shortages. A recent study by Blue Health Intelligence indicates that many individuals using GLP-1 drugs solely for weight management, discontinue treatment before reaching week 12, suggesting that they were unlikely to achieve clinically meaningful weight loss. Providers are advised to be aware of emerging studies and assess the availability of Wegovy before starting patients on this medication.
Due to recent changes, the Centers for Medicare and Medicaid Services (CMS) now allow anti-obesity medications to be covered through Medicare Part D if there are other medically accepted indications besides weight loss. Currently, Wegovy is non-formulary. Members seeking coverage for the reduction of the risk of major adverse cardiovascular events need to request a formulary exception per the standard process.
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