Medicare Now Covers Weight Loss Drug

Medicare Now Covers Weight Loss Drug #Wegovy: NYC Weight Loss MD, Sue Decotiis, Explains Eligibility - News Nation
US health insurance companies have agreed to start paying for the cost of weight loss drugs like Wegovy. This is a huge milestone for many Americans hoping to get that high profile drug covered. Only certain patients with heart related conditions and Medicare will be able to get wegovy mostly paid for. Joining us to discuss what you need to know is New York City weight specialist doctor Sue Decotiis. Welcome to the show.
Nice to have you.
So Medicare will cover the popular weight loss drug Wegovy for some. What are the qualifications patients need to get this medication covered?
Well, they're definitely covered if they're type two diabetics and now they're covering a three pre-diabetes. And that's when somebody's hemoglobin A1C is edging up. And now it's covered for heart disease. And this is really great. The FDA looked at it in January and said gee this really helps heart patients and kind of shoveled it through to get the approval. And that's why Medicare is covering it. And what I find fascinating is the medical weight loss specialist is how these weight loss drugs are helping people in their general health. Now, it works in heart disease in two ways. It helps lower risks by lowering cholesterol, blood pressure, and also weight, of course, but it also helps increase the amount of blood that the heart can pump. And there's less inflammation in the heart as well. I mean, there are two very inflammatory factors that can be measured in the blood that go down in patients with heart disease. So it's very exciting.
It is exciting. It's so interesting. So if patients realize, hey, I fit all the symptoms, I have all the symptoms that you just mentioned, doctor, where do you start to find the coverage?
Well, your doctor is going to have to get a pre-authorization for you and that is not easy. Okay? It's a lot of work for the doctor. The other issue too is shortages of these medications. Now we're talking about shortages of ozempic and wegovy and also shortages of monjaro, which is the other, the newer Ozempic and Wegovy, which is FDA approved for weight loss. So there are shortages of all these medications. So the problem for a patient is if a patient is going on this for heart disease, let's say an older patient, and then they can't get the drug due to shortages, what is the patient do. So this is something that's very practical. And patients that are getting getting it covered through private insurance, a lot of times the insurance company will just stop covering it. That's a.
Good point. So what kind of documentation will Medicare patients need to ensure coverage?
Well, that's all the physician's issue. So the physician has to document that there really is heart failure, that they've tried a lot of other drugs, etc.. Now in my practice I treat usually a younger group of patients. And my focus is really in New York City is on preventing all of these from happening. So a lot of patients that even aren't covered are going to want to pay for it because they want to reduce their risks, they want to lose weight, and perhaps they're never going to get diabetes and heart disease. So prevention really has to be looked at. It's great that these drugs are used to treat diseases. But let's look at the millions and millions of people who could benefit from taking these drugs earlier on to get their weight down.
Are there other conditions that can also get coverage for these weight loss drugs that are, to your point, highly coveted?
It's really right now just obesity, being overweight with one underlying condition like high blood pressure, high cholesterol. Medicare is now covering it for prediabetes.
Sue Decotiis, MD
20 E 46th St., #1201
New York, NY 10017
Phone: [phone]
www.drdecotiis.com/ozempic-semaglutide-mounjaro-tirzepatide-weight-loss-doctor-manhattan-nyc
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