By: David Ostrowsky

As if there weren’t enough buzz surrounding Wegovy.

Earlier this month, the wildly popular weight loss medication was approved in the US to help prevent life-jeopardizing cardiovascular events in people who are overweight, obese, and/or have a history of cardiovascular disease. The FDA’s stamp of approval for drugmaker Novo Nordisk to include cardiovascular benefits to Wegovy’s label meant it was the first weight loss drug to market itself in this manner. Now the million-dollar question (no pun, intended) becomes, will this label expansion make insurers feel more inclined to provide coverage? For good measure, will Medicare, currently barred by law from covering drugs for weight loss alone, be compelled to include Wegovy under its umbrella? 

Currently, Wegovy costs over $1,300 per month before any applied discounts. Obviously, for nearly every single American, this out-of-pocket cost is prohibitively expensive – especially considering that many patients may need to take it for the rest of their lives. Furthermore, the age-old rule of supply and demand suggests that the price isn’t likely to drop anytime soon: amid soaring demand for Wegovy, Novo Nordisk has struggled to maintain an adequate supply, although the company has pledged to boost production for the balance of 2024. (Novo Nordisk has also asked European Union regulators to expand the use of the drug for heart problems; however EU regulators have not responded to the request.) Unfortunately, many Americans – whether they are on private employer-sponsored plans or government-sponsored ones – have not been able to get financial relief from their insurance. Wegovy is simply too costly and – until this month at least – considered primarily to be a vanity drug.

But now there appears to be irrefutable evidence that Wegovy doesn’t just help people get ready for their new stylish beachwear, but actually prolongs life by reducing the risks of cardiovascular issues surfacing amongst the most vulnerable patients. Consider that the recent FDA approval stemmed from a 17,000-patient study that demonstrated that people taking Wegovy had a 20 percent lower risk of experiencing a cardiac event than those taking the placebo. It is important to note that the participants already had some form of cardiovascular disease and it has been suggested that further studies need to be conducted to demonstrate whether there are benefits for those who haven’t experienced a cardiac event. Regardless, the salubrious effects are undeniable. As Dr. Melanie Jay, director of the N.Y.U. Langone Comprehensive Program on Obesity, told the New York Times, “when you treat obesity seriously in people who have a high burden of disease, you can get really good outcomes.” Meanwhile, the more common side effects of Wegovy, which have been reported to include nausea, diarrhea, vomiting, and constipation, do manifest themselves in many patients (for older ones, it is fairly common to experience a loss of muscle mass), but are not considered as severe as those that have been linked to weight loss drugs in the past.

Ultimately, many insurers and self-funded plans are now scrambling to justify how they can deny coverage of a medically necessary medication. But aside from the optics, insurers and plan sponsors may have an understandably pragmatic reason to start providing coverage of Wegovy: while covering even some of the costs may seem imposing, the considerable outlay could be offset by the savings realized from reduced spending on long-term medical care relating to obesity and heart disease.

Stay tuned.