WSJ: Elevance Health, Aetna widen coverage for Wegovy following CMS guidance

UPDATED on March 28 at 2:15 p.m. ET

Following a report that Medicare would cover obesity drugs for patients with certain heart conditions, the Wall Street Journal now reports that multiple major payers are following suit.

CVS Health's Aetna, Elevance Health and Kaiser Permanente said they would cover Wegovy as a way to reduce heart attack risk in patients with cardiovascular conditions, who meet certain body weight criteria and are enrolled in Medicare drug coverage, according to the article.

Elevance Health said that coverage will also be extended to epople enrolled in its commercial plans, according to the report.

Humana told the outlet that it is reviewing the new guidance from the Centers for Medicare & Medicaid Services, and UnitedHealthcare declined to comment.

Medicare Part D may cover obesity drugs when they secure approval for additional, medically accepted uses, according to a report in The Wall Street Journal.

The Centers for Medicare & Medicaid Services (CMS) told the newspaper exclusively that the guidance would apply to Novo Nordisk's Wegovy, which just received approval from the Food and Drug Administration to reduce risk of stroke or heart attack in people with cardiovascular disease and a body mass index over a certain threshold.

A recent study found that Wegovy lowered cardiovascular risk by about 20%, the WSJ reported.

Medicare serves as a bellwether for the industry, and coverage decisions made in the program are often emulated in the commercial sector. Addressing coverage and the high cost associated with Wegovy and other similar drugs, called GLP-1s, is a key concern for insurers, employers and other plan sponsors.

CMS told the WSJ that it had clued insurers in on the coverage update as of Wednesday. While the new guidance could open the door for broader coverage of GLP-1s that secure additional indications, it would not extend Part D coverage to these therapies to address obesity on its own, according to the article.

The new guidelines also would not impact other competitors in this space, Ozempic and Mounjaro, which are more frequently prescribed for diabetes. Part D plans generally already cover these drugs for diabetes, according to the article.

CMS also added that plans can require prior authorization on these drugs, WSJ reported.