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Doctors Struggle to Secure Medicare Coverage for Heart Patients on Novo Nordisk's Wegovy

Doctors Struggle to Secure Medicare Coverage for Heart Patients on Novo Nordisk's Wegovy

医生们努力争取让诺和诺德公司的Wegovy获得医保覆盖,适用于心脏病病人。
Benzinga ·  08/16 13:59

Older Americans are having little success getting prescriptions for Novo Nordisk A/S's (NYSE:NVO) weight-loss drug Wegovy, covered by Medicare, despite the federal healthcare program's decision to pay for patients with obesity at risk of heart disease.

尽管联邦保健计划决定为患有心脏病风险的肥胖病患者支付费用,但年长的美国人在获取纽达斯克药业(NYSE:NVO)的减肥药物Wegovy的处方并由医保计划批准付费方面一直没能取得成功。

In interviews with Reuters, seven obesity and heart disease specialists from various parts of the United States said their prescriptions for Novo Nordisk's drug have been repeatedly denied by the healthcare companies that administer Medicare drug benefits. Some prescriptions were approved only after an appeal for each application.

在接受路透社采访时,来自美国各地的七位肥胖病和心脏病专家表示,美国医保药品福利计划的管理公司一再拒绝了他们对纽达斯克药业的药物处方。只有在每次申请上诉后,一些处方才获得批准。

Also Read: Don't Promote Copycat Weight-Loss Drugs Amid Improved Supply, Eli Lilly Asks Doctors, FDA Evaluates.

另请参阅:不要在供应改善时推广山寨减肥药,礼来要求医生,美国食品药品监督管理局正在评估。

One doctor said that none of the ten or more appeals she sends each month are granted. Two other physicians said their success rate with appeals was between 10% and 50% for patients with a history of heart attack or stroke.

一名医生表示,她每个月发送的十个或更多上诉都没有得到批准。另外两位医生表示,他们针对有过心脏病发作或中风病史的患者的上诉成功率在10%至50%之间。

Medicare, which provides medical coverage for Americans age 65 and older, is prohibited by law from paying for weight-loss drugs or other types of lifestyle medicines.

美国医保计划向65岁及以上的美国人提供医疗保障,但根据法律,医保不得支付减肥药物或其他类型的生活方式药物的费用。

Wegovy, a weekly injection, carries a list price of more than $1,300 per month, prompting calls from President Joe Biden's administration and some lawmakers for Novo to lower its price.

Wegovy是一种每周注射的药物,标价超过每月1300美元,这促使美国总统乔·拜登的政府和一些立法者要求纽达斯克公司降低价格。

With nearly 70% of U.S. adults considered obese or overweight, the cost of covering it for even a fraction of those patients would run into billions of dollars.

近70%的美国成年人被认为是肥胖或超重,为其提供覆盖甚至一小部分患者的费用将需要花费数十亿美元。

Citing a Novo Nordisk spokesperson, Reuters noted that the company will continue working with payers and policymakers to ensure that seniors with obesity have insurance coverage.

路透社援引纽达斯克公司的一位发言人的话称,该公司将继续与付费方和政策制定者合作,确保患有肥胖病的老年人可以获得保险。

A July analysis by KFF, a non-profit that conducts health policy research, showed that only 1% of plans for Medicare patients offered by these middlemen covered Wegovy for heart disease.

KFF是一家进行健康政策研究的非营利机构,7月的分析显示,供应商提供给医保患者的计划仅有1%包括Wegovy用于心脏病的覆盖范围。

Juliette Cubanski, deputy director of KFF's program on Medicare policy, said plan sponsors often wait until the start of the calendar year to begin coverage of a newly approved prescription drug. Cubanski said she expects more Medicare plans to start covering Wegovy next year, although even then "we'll see variation in coverage for this drug, just as we do for other expensive medications."

KFF的Medicare政策计划副主任Juliette Cubanski表示,计划赞助商通常会等到新批准的处方药开始覆盖的日历年初才开始覆盖。Cubanski表示,她预计明年会有更多的医保计划开始覆盖Wegovy,尽管在那种情况下,“我们将看到这种药物的覆盖范围存在差异,就像其他昂贵药物一样。”

They may need to widen coverage even further. Eli Lilly And Co's (NYSE:LLY) clinical trials have shown its obesity drug Zepbound can help treat obstructive sleep apnea. Lilly is seeking FDA approval for that use and expects the drug would then be covered by Medicare.

它们可能需要进一步扩大覆盖范围。艾礼王(Eli Lilly And Co,NYSE:LLY)的临床试验表明,其肥胖症药物Zepbound可以帮助治疗阻塞性睡眠呼吸暂停。礼来正在寻求FDA批准用于该用途,并预计该药物随后将由医保计划进行覆盖。

Price Action: NVO stock is down 1.66% at $135.29 at the last check on Friday.

股价行情:截至上周五最后检查,NVO股价下跌1.66%至135.29美元。

Photo by Tobias Arhelger via Shutterstock

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