Radar on Medicare Advantage

Wegovy Coverage Question Puts Part D Plans in Tricky Position

  • Apr 04
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    Apr 04, 2024

    In newly released guidance, CMS told Medicare Part D plans that they’re allowed to cover weight-loss drugs if they’ve been approved for another medical use — a description fitting Novo Nordisk’s Wegovy (semaglutide) after it recently received an FDA nod for preventing major heart problems.

    So far, CVS Health Corp., Elevance Health, Inc. and Kaiser Permanente have said their Part D plans will cover Wegovy for its newest approved use: reducing the risk of heart attacks and strokes in people who have cardiovascular disease and who meet body-weight criteria, the Wall Street Journal reported on March 28.

    For other insurers that sell Part D plans, the decision about whether to cover Wegovy represents an additional challenge to grapple with, as they’re also facing significant regulatory changes.

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    • Lauren Flynn Kelly

    Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.

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Meet Our Reporters

Lauren Flynn Kelly

Executive Editor, AIS Health, and Managing Editor, Radar on Medicare Advantage

View Lauren Flynn Kelly's Profile

Angela Maas

Managing Editor, Radar on Specialty Pharmacy and Spotlight on Market Access

View Angela Maas's Profile

Leslie Small

Managing Editor, Health Plan Weekly and Radar on Drug Benefits

View Leslie Small's Profile

Tim Casey

Reporter, Health Plan Weekly and Radar on Drug Benefits

View Tim Casey’s Profile

Carina Belles

Reporter, Radar on Medicare Advantage and Spotlight on Market Access

View Carina Belles's Profile

Jinghong Chen

Reporter, Health Plan Weekly and Radar on Drug Benefits

View Jinghong Chen's Profile

Jill Drachenberg

Reporter, Health Plan Weekly and Radar on Drug Benefits

View Jill Drachenberg's Profile

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Medicare Part D
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