There has been much attention in the media to an announcement from Medicare in mid-March 2024. In essence, it said that it has now agreed to start paying for one of the leading weight-loss drugs for people with heart problems when it is prescribed to treat overweight or obese patients if they are at risk of heart attacks and strokes. This opens new options for treating heart failure and lowering the risks of stroke and heart attack for patients. Until now, they were required to pay very high prices for these new drugs, even if they had Medicare insurance coverage.
Before going into all the details of why Medicare has taken this step and what it could mean for the general public, it’s important to understand that the new agreement is limited to people who have subscribed to Medicare Part D drug plans. This means it is relevant to the approximately 50 million people with Part D insurance coverage. Unless you have this cover or add it to your existing Medicare (Advantage, Plan A, or Plan B), the new extension to cover weight-loss drugs may not be relevant to you.
However, even if you don’t benefit directly from the new Medicare policy, this could still open new options for treatment with the most advanced medications. Now, the most important Federal Government agency that deals with healthcare has recognized the value of treating heart failure with weight-loss medications. This means that doctors will be able to adapt their treatment plans to their patients with greater flexibility.
Until now, one of the main obstacles to doctors recommending weight-loss drugs has been the refusal of insurance companies to bear the cost, leading to patients having to pay substantial prices out of their own pockets. For most Americans who don’t have Medicare Part D coverage, the cost of the medication remains one of the most substantial barriers to wider use of these meds.
Fortunately, we can offer several separate and distinct alternatives to people in this position.
- The high-cost weight-loss medications can be sourced at lower costs directly from our associate company Rxfor.me which can provide the full service of prescription and medication supply in just a few simple steps. Obtain the right weight-loss program at an affordable price. Rxfor.me offers access to an online experienced medical team and partners with pharmacies that can provide the most frequently prescribed weight-loss medications, including Ozempic, Saxenda, and Rybelsus.
- Another group of medications, based on a different principle, has now been recognized as having significant potential for treating cardiovascular diseases. The drugs are built on sodium/glucose cotransporter 2 (SGLT2) inhibitors, originally developed to treat type 2 diabetes (the same condition as was the initial target of Ozempic and the other newly approved drugs). Several research studies (for example, here and here) have demonstrated that treatment of patients with heart and kidney problems with SGLT2 drugs has beneficial effects regardless of whether or not they also had diabetes.
The most frequently prescribed SGLT2 drug is Jardiance (empagliflozin), which was originally developed as a treatment for type 2 diabetes but has since been proven to be an effective treatment for kidney failure and a range of heart problems. When the heart’s left ventricle (upper chamber) cannot contract effectively, this leads to a lower volume of blood ejected from the heart during each heartbeat. This can be caused by various underlying conditions, including coronary artery disease, hypertension, and defects in the heart muscles, which ultimately compromise the heart’s function. The technical name of the condition is Heart failure with reduced ejection fraction (HFrEF). Almost one-half of the approximately 6 million American adults who have been diagnosed as suffering from heart failure are categorized as having HFrEF.
Why did Medicare take steps to cover weight-loss drugs?
This move to approve weight-loss drugs for people with heart problems is understandable since there is a growing body of opinion amongst healthcare specialists that many of the new weight-loss treatments have strong secondary benefits when it comes to lowering the chances of heart attack or stroke. There was already considerable evidence based on the extensive SELECT trials conducted on diabetic patients that established strong links between benefits coming from semaglutide in improving survival rates for patients who had preexisting cardiac problems as well as type 2 diabetes.
At the end of 2023, researchers presented new evidence to the American Heart Association. It proved that the leading drugs for treating diabetes (brand-name Ozempic) and weight-loss (brand-name Wegovy), both based on the generic semaglutide, were effective in preventing heart attack and stroke. They also improved the symptoms of patients with heart failure with preserved ejection fraction (HFpEF).
The benefits of semaglutide in lowering the risk of cardiac failure in diabetes patients were established several years before. Still, a new study was conducted over five years, ending in October 2023. Subjects in the trial were aged 45 or older, had a Body Mass Index of at least 27 (at least overweight), and had some form of cardiovascular disease but with normal blood sugar levels. At the end of the trial, it was found that those who had been given semaglutide had the risk of serious cardiovascular events reduced by 20%. Further, the risk of a heart attack was 28% lower, and of a stroke was 7% lower. There was also an observed reduction in “bad” cholesterol and blood pressure and a lower HbA1c level, which means average blood sugar levels were lower over a three-month window.
What about people who do not have Medicare Plan D insurance?
Getting weight-loss drugs for people with heart problems prescribed by doctors and the payment approved by healthcare insurers other than Medicare Plan D is not as straightforward as it sounds. As we wrote in our blog in February 2024, titled Why it’s so hard to get your weight-loss drugs, getting insurance companies to approve payment for these newer drugs for conditions other than type 2 diabetes is becoming increasingly difficult. It’s even getting to the point that patients with diabetes are also getting prescriptions for newer drugs like Ozempic and Mounjaro rejected by their insurance plans, and doctors are having to fall back on much older medications like Metformin.
When the drugs based on semaglutide and its companion, tirzepatide, were first released for diabetes treatment, most insurance companies did pay some part of the cost of the medications. As a matter of policy, these insurers did not cover weight-loss medication. This meant that patients had to pay the total cost. There was a tsunami of demand for the GLP-1 drugs. Most of the insurance companies became aware that many prescriptions for these drugs were being given to people who were not in fact diabetic. The solution for them was to restrict their exposure to the skyrocketing costs by tightening the rules on issuing prescriptions for these meds for all patients, including diabetics.
The rules vary from insurer to insurer, plan to plan, and even state to state within the same insurer. Some doctors are even receiving instructions that they should only issue a prescription for Ozempic or Mounjaro to treat a diabetic patient when they can fully validate their decision to the insurer. They may even be required to change treatment back to older methods when the patient cannot pay the full price. In other cases, the person has to get a prior agreement from the insurance company before a doctor can issue the prescription. This can delay the issuing of the prescription and receipt of the drug for weeks or even months.
