Heart Benefits of Obesity Drug Raise Hope for Medicare Coverage

August 10 (Reuters) – New data on the effectiveness of an obesity drug developed by Novo Nordisk and Eli Lilly has increased the likelihood of government reimbursement and coverage by Medicare, according to analysts and experts. Currently, weight-loss treatments are classified as lifestyle drugs and are not covered by Medicare. However, Novo and Eli Lilly have spent nearly $1.3 million on lobbying efforts this year to push for a bill that would allow Medicare to reimburse these medicines.

Novo’s obesity drug, Wegovy, has been shown to reduce the risk of heart attacks and strokes by 20%. The drugmaker plans to seek regulatory approval for its use as a cardiovascular treatment, a move that could potentially pave the way for Medicare coverage. Stacie Dusetzina, a professor at Vanderbilt University, believes the trial results may provide an avenue for coverage for individuals who have previously experienced a heart attack or stroke.

Wegovy, along with Eli Lilly’s Mounjaro, a similar diabetes treatment expected to be approved for obesity this year, are two of the fastest-growing drugs in the country. However, their high cost, with a price tag of over $1,000 per month, has led to a decrease in prescriptions due to supply issues.

Novo Nordisk’s Chief Financial Officer, Karsten Munk Knudsen, expressed optimism about the new data’s impact on discussions with public health authorities and payers. He believes it will make a significant difference for patients, prescribers, and payers in evaluating the value of obesity care treatments.

The positive outcome of the study is expected to encourage payers, including insurance companies, employers, and Medicare, to increase coverage for weight-loss drugs. However, experts caution that passing a law to increase costs for Medicare, which covers about 66 million people primarily aged 65 and older, may face challenges.

Novo Nordisk and Eli Lilly have significantly increased their lobbying efforts in recent years. In the first half of this year alone, Novo’s lobbying expenditure reached $630,000, almost two-thirds of its reported spending for the entire year in 2022. Eli Lilly also spent $640,000 collectively in the first half of this year on lobbying for Medicare coverage of weight-loss drugs.

Despite the increased spending, some experts are skeptical about the prospects of bipartisan support for changing Medicare policy due to the challenging political environment. Vanderbilt’s Dusetzina notes that passing legislation, even for policy goals that most people agree with, poses significant challenges.

In conclusion, the new data on the heart benefits of an obesity drug developed by Novo Nordisk and Eli Lilly has raised hope for potential Medicare coverage. The drug has shown promising results in reducing the risk of heart attacks and strokes by 20%. Novo and Eli Lilly’s lobbying efforts have aimed to push a bill that would allow Medicare reimbursement for weight-loss drugs. While the study’s positive outcome is expected to encourage increased coverage by payers, passing legislation to increase costs for Medicare may prove challenging in the current political environment.