Finally, Coverage for the Condition of Overweight/Obesity?

For many people, weight management medications are completely excluded from insurance coverage. Why can treatment for a medical condition be excluded from my health insurance, many people ask? Don’t the insurance companies know that this contributes to or causes many of my other health conditions? Well, for the first time, in March, a weight management medication received FDA approval for something other than “just” weight loss. In March, the FDA approved Wegovy to reduce the risk of cardiovascular events in people with known cardiovascular disease and overweight or obesity. Could this be the start of treating (and paying for) overweight and obesity as the medical condition that it is? It looks like it may be, as Medicare will now cover Wegovy under Part D for people with a known cardiovascular disease and overweight or obesity and commercial payors typically follow Medicare’s lead.

What does this mean for you? If you have known cardiovascular disease, such as a history of heart attack, stroke, or peripheral arterial disease, and overweight or obesity, talk to your medical provider about potential risks and benefits for you. If they do not treat this condition, ask for a referral to someone who does.

Take Back Your Cardiovascular Health,

Valerie Hope-Slocum Sutherland, MD

For more information, here are links:

FDA Approves First Treatment to Reduce Risk of Serious Heart Problems Specifically in Adults with Obesity or Overweight | FDA

Medicare Will Cover the Weight Loss Drug Wegovy to Reduce Heart Disease Risk (everydayhealth.com)

Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes - PubMed (nih.gov)