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Part D Plans Bracing For Wegovy; Strict Prior Authorizations To Prevent Obesity Use Are Likely

 
• By Cathy Kelly

Despite worries about potential costs of inadvertently covering Wegovy for obesity because of patient (and physician) gaming, Novo’s new CV claim expected to garner wide formulary adoption. Since coverage for weight loss drugs is still prohibited in Medicare, CMS may issue guidance.

Access To Wegovy Likely To Be Tightly Controlled • Source: Shutterstock

Medicare Part D sponsors are expected to cover Novo Nordisk’s Wegovy for its newly-approved indication for cardiovascular risk reduction in patients with obesity but will look to prior authorizations to block reimbursement for obesity alone.

Plans may be worried that the cardioprotective indication gives Wegovy (semaglutide) a foot in the door that patients will try...

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