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Medicare will now cowl Wegovy (semaglutide) for people who find themselves obese or have weight problems and who’ve an elevated threat of coronary heart assaults, strokes, or different doubtlessly life-threatening cardiovascular issues.
Weight reduction medicine have lengthy been excluded from Medicare protection. However a spokesperson for the Facilities for Medicare and Medicaid Companies (CMS) mentioned in an emailed assertion that the U.S. Meals and Drug Administration (FDA) determination earlier this month to approve Wegovy for the prevention of coronary heart assaults and strokes prompted Medicare so as to add the medication to its Half D prescription drug plans.
Different anti-obesity medicines nonetheless aren’t lined, and Wegovy protection continues to be restricted to individuals with coronary heart illness who might profit from weight reduction.
“A drug that receives FDA approval for power weight administration alone wouldn’t be thought of a Half D drug,” the CMS spokesperson mentioned. “If this identical drug additionally receives FDA approval to deal with diabetes or scale back the danger of main opposed cardiovascular occasions in adults with established heart problems and both weight problems or obese, then it will be thought of a Half D drug for these particular makes use of solely.”
Proper now, Wegovy is the one FDA-approved weight reduction drug that meets this commonplace.
Wegovy Presents Clear Survival Advantages
The clear survival advantages seen with Wegovy on this trial helped with its added FDA approval and Medicare protection, says Melanie Jay, MD, an affiliate professor and the director of weight problems analysis on the New York College Grossman Faculty of Medication in New York Metropolis.
“I believe it has taken a very long time for weight problems to be totally acknowledged as a illness,” Dr. Jay says. “There may be nonetheless loads of weight problems stigma and policymakers should consider that creating weight problems is the affected person’s fault.”
Alternatively, there haven’t been many research exhibiting a survival profit with weight reduction medicine, Jay says.
“I believe Medicare will solely cowl medicines which have confirmed threat discount, so I do not see protection increasing to, say, tirzepatide (Zepbound) simply but,” says Jody Dushay, MD, an endocrinologist at Beth Israel Deaconess Medical Heart and an assistant professor at Harvard Medical Faculty in Boston. The identical goes for older weight reduction tablets like Qsymia (phentermine/topiramate) and Contrave (naltrexone/bupropion).
Past this, ongoing drug shortages might make it onerous for Medicare sufferers who now qualify for Wegovy protection to entry the drug, particularly on the decrease beginning doses individuals want to reduce negative effects as they begin therapy, Dr. Dushay says.
Wegovy Shortages Proceed
“Proper now there are deep and seemingly endless shortages of Wegovy on the beginning doses,” Dushay says. “So, virtually talking, for the following a number of months I am undecided how individuals will truly get this treatment into their fingers.”
Over the long term, nevertheless, one upside of the Medicare determination to cowl Wegovy is that personal insurers that present worker well being advantages to tens of millions of Individuals might quickly do the identical, says Adam Gilden, MD, an affiliate professor on the College of Colorado Faculty of Medication and the affiliate director of the CU Weight Administration and Wellness Clinic in Aurora.
“Usually personal insurance coverage follows the lead of Medicare,” Dr. Gilden says.
Muscle Loss Is a Concern for Older Adults Taking Wegovy
One concern that comes with extra sufferers, particularly older adults, on Wegovy is the potential for the drug to trigger what’s generally known as sarcopenia, a gradual lack of muscle mass that sometimes happens as individuals age. Speedy weight reduction could cause sarcopenia at any age, however the issues are heightened for older adults who’re already at excessive threat and should grow to be extra susceptible to frailty, falls, and fractures as their muscle operate declines.
“I believe we at all times fear in regards to the aged creating sarcopenia, which is when muscle is changed by fats,” says Shauna Levy, MD, an assistant professor at Tulane College Faculty of Medication and the medical director of the Tulane Weight Loss Heart. “Wegovy can expedite this.”
However the advantages of Wegovy, particularly for heart problems, outweigh the dangers, Dr. Levy says. “Customers of those medicines ought to proceed to carry out train, particularly resistance coaching, as a lot as doable of their schedule to reduce muscle loss.”
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