Monday, April 22, 2024

Is Wegovy Covered By Insurance? These Insurers Offer Coverage

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The first major health insurance companies in the U.S. will start paying for Novo Nordisk’s popular weight loss injection Wegovy, according to a Wall Street Journal exclusive report published Friday.

Kaiser Permanente, Elevance Health, and CVS Health’s Aetna insurance unit said in statements that they would cover Wegovy, also known as semaglutide, to reduce the risk of heart attack and stroke. The news arrives one week after the U.S. Centers for Medicare and Medicaid Services stated that beneficiaries under Medicare would be covered for Wegovy if it was prescribed to manage heart health.

Related: Popular Appetite Suppressant Ozempic Can Be Made For Less Than $5 a Month, New Research Suggests

The Wegovy coverage begins immediately for some plans, like Kaiser Permanente’s, while other plans, like those from Elevance, will start covering the drug in the weeks to come.

Wegovy is an injectable prescription weight loss medicine. (Photo by: Michael Siluk/UCG/Universal Images Group via Getty Images)

Earlier this month, the U.S. Food and Drug Administration approved Wegovy for heart health based on a global study published last year in the New England Journal of Medicine that showed that the drug could reduce the risk of heart attack and stroke by 20%. The drug had previously only been approved in the U.S. for diabetes, according to Bloomberg.

The study included 17,604 people ages 45 and up from 41 countries and tracked them for at least three years on average. The goal was to examine how Wegovy impacted heart disease and weight, but not diabetes.

The participants who received weekly injections of Wegovy lost about 9% of their body weight and saw improvements in blood pressure, blood sugar, cholesterol levels, and inflammation.

“We are very pleased that Wegovy is now approved in the U.S. as the first therapy to help people manage their weight and reduce cardiovascular risks,” Martin Holst Lange, executive vice president and head of development at Novo Nordisk, told the WSJ.

Related: Novo Nordisk Is Worth More Than Denmark’s GDP Thanks to America’s Ozempic and Wegovy Craze

The study did uncover downsides to Wegovy, with about a third of participants experiencing serious side effects. About 17% of those who took Wegovy left the study because of stomach-related issues like nausea, reported the Associated Press.

Wegovy costs $1,349 every month if an individual opts to use it without insurance coverage in the U.S.

A recent study on weight loss drugs showed that a similar offering from manufacturer Novo Nordisk called Ozempic, which goes for close to $1,000 per month and is a lower-dose version of Wegovy, could be profitably made for far less than its current market price.

When the researchers calculated a cost-based price for Ozempic that included a profit margin, operating costs, and tax, they found a price ranging from $0.89 to $4.73 per month — far lower than the $935.77 that Ozempic currently costs out of pocket in the US.

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