Wegovy Approved by Anthem for Cardiovascular Indication

05-29-2024

Anthem Large Group, National Account, Small Group | CA, CO, CT, GA, IN, KY, ME, MO, NV, NH, NY, OH, VA, WI

The FDA has approved Wegovy, currently used to treat weight loss, for cardiovascular (CV) treatment, effective July 1, 2024. Wegovy for CV treatment will be treated differently than Wegovy for weight loss.

Anthem’s specialty pharmacy, CarelonRx will manage Wegovy for CV differently from Wegovy for weight loss and will treat Wegovy for CV similar to other CV drugs. Wegovy for weight loss will continue to be an excluded drug unless opted-in by the client. For clients who do not cover Wegovy as part of their weight loss benefits, we will review this drug to ensure evidence-based, clinically appropriate use for the CV indications.

What this means for clients:

• Those who cover the weight loss drug class may see Wegovy utilization because a small number of members may meet the approved criteria.
• Those who do not cover the weight loss drug class may see Wegovy utilization for the CV indication in their claims.

With strict clinical guidance, CarelonRx will ensure evidence-based, clinically appropriate use of Wegovy for CV by our members. This Wegovy CV criterion was approved by an independent, external committee of about 20 physician and pharmacist specialists, primarily practicing at academic medical centers, and who have expertise in evidence-based medicine.

If you have questions regarding these updates or have clients who may be interested in changing the weight loss drug coverage on their benefit plan, please contact BUA.