Wegovy, a popular weight-loss drug in high demand, can now be covered by Medicare and Medicaid provided patients using it have heart disease.
A recent trial that enrolled over 17,000 participants demonstrated that Wegovy reduced the risk of heart attack, stroke and cardiovascular disease by 20% compared to placebo. The participants were overweight or obese and had established cardiovascular disease but not diabetes. The landmark trial was the first to show that a class of obesity drugs could provide long-term benefits to heart health in those who are overweight or obese.
Semaglutide, the active ingredient in Wegovy, mimics the naturally occurring hormone glucagon-like peptide-1 which delays the emptying of food from the stomach and acts on hunger centers in the brain to reduce cravings. It also stimulates the pancreas to release insulin to decrease blood sugar levels.
Now that Medicare will cover Wegovy, many other drug manufacturers will also look to get approval of additional anti-obesity medications if they can demonstrate their benefits beyond weight loss. Zepbound, for example, is a similar but different drug used to treat obesity that is currently not covered by Medicare and Medicaid. According to reports from Reuters, obesity experts believe that Eli Lilly, Zepbound’s manufacturer, will demonstrate evidence that its drug will also provide cardiovascular benefits in addition to weight loss. This trend could open the door for other drug companies to accelerate research to show their drugs provide added benefit to obtain Medicare coverage.
Wegovy is not cheap by any means and remains in high demand. A monthly supply of the drug can cost over $1,300, according to information from SingleCare. This could result in enormous healthcare spending by the federal government, with analysts forecasting the market for weight-loss drugs reaching $100 billion a year by the end of the decade, according to reports from Reuters. The demand for these drugs will likely supersede the supply, as 5% of Americans have coronary heart disease (the most common form of heart disease) and more than two in five American adults have obesity, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
As Wegovy becomes more popular and is prescribed more often, the propensity for side effects will also be amplified in the population. Although generally a safe drug, common side effects include nausea, vomiting, diarrhea and constipation. Rarely, the drug can be associated with inflammation of the pancreas, gallbladder problems, kidney failure, depression, suicidal thoughts and even some thyroid tumors. Those who take Wegovy would need to be monitored carefully for some of these more serious side effects.
Finally, an unintended consequence of Wegovy becoming more accessible could be patients attempting to obtain diagnoses of heart diseases in an effort to get Wegovy cheaper from Medicare coverage. Medicare will cover Wegovy for overweight patients or obese patients with heart disease, but not for obesity alone.
But what exactly does heart disease mean? Do patients who experience transitory high blood pressure qualify for Medicare coverage of Wegovy since high blood pressure is a clear risk factor for heart disease? Patients may blur the line in attempting to present themselves as patients of heart disease, and physicians may start prescribing Wegovy based on the presumption of reducing the risk of heart disease in certain patients who would otherwise only have minimal risk.
Despite financial hurdles and unintended public health consequences, Wegovy becoming more accessible through Medicare coverage could put a dent in cardiovascular disease, which remains the No. 1 cause of death in America. In addition, it could simultaneously curb the obesity epidemic in America, providing relief to millions of Americans.
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