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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

醫生們努力爭取讓諾和諾德公司的Wegovy獲得醫保覆蓋,適用於心臟病病人。
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.

儘管聯邦保健計劃決定爲患有心臟病風險的肥胖病患者支付費用,但年長的美國人在獲取紐達斯克藥業(NYSE:NVO)的減肥藥物Wegovy的處方並由醫保計劃批准付費方面一直沒能取得成功。

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.

在接受路透社採訪時,來自美國各地的七位肥胖病和心臟病專家表示,美國醫保藥品福利計劃的管理公司一再拒絕了他們對紐達斯克藥業的藥物處方。只有在每次申請上訴後,一些處方才獲得批准。

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

另請參閱:不要在供應改善時推廣山寨減肥藥,禮來要求醫生,美國食品藥品監督管理局正在評估。

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.

一名醫生表示,她每個月發送的十個或更多上訴都沒有得到批准。另外兩位醫生表示,他們針對有過心臟病發作或中風病史的患者的上訴成功率在10%至50%之間。

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.

美國醫保計劃向65歲及以上的美國人提供醫療保障,但根據法律,醫保不得支付減肥藥物或其他類型的生活方式藥物的費用。

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是一種每週注射的藥物,標價超過每月1300美元,這促使美國總統喬·拜登的政府和一些立法者要求紐達斯克公司降低價格。

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%的美國成年人被認爲是肥胖或超重,爲其提供覆蓋甚至一小部分患者的費用將需要花費數十億美元。

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.

路透社援引紐達斯克公司的一位發言人的話稱,該公司將繼續與付費方和政策制定者合作,確保患有肥胖病的老年人可以獲得保險。

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是一家進行健康政策研究的非營利機構,7月的分析顯示,供應商提供給醫保患者的計劃僅有1%包括Wegovy用於心臟病的覆蓋範圍。

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政策計劃副主任Juliette Cubanski表示,計劃贊助商通常會等到新批准的處方藥開始覆蓋的日曆年初才開始覆蓋。Cubanski表示,她預計明年會有更多的醫保計劃開始覆蓋Wegovy,儘管在那種情況下,「我們將看到這種藥物的覆蓋範圍存在差異,就像其他昂貴藥物一樣。」

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.

它們可能需要進一步擴大覆蓋範圍。艾禮王(Eli Lilly And Co,NYSE:LLY)的臨床試驗表明,其肥胖症藥物Zepbound可以幫助治療阻塞性睡眠呼吸暫停。禮來正在尋求FDA批准用於該用途,並預計該藥物隨後將由醫保計劃進行覆蓋。

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

股價行情:截至上週五最後檢查,NVO股價下跌1.66%至135.29美元。

Photo by Tobias Arhelger via Shutterstock

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