Until recently, the FDA had only approved Wegovy for weight loss. In March 2024, Wegovy gained FDA approval for an additional indication for the reduction of cardiovascular (CV) events in overweight or obese patients with a history of cardiovascular disease. Based on the clinical trial, evidence-based prior authorization criteria have been developed and will go into effect on September 1, 2024. We anticipate minimal member utilization due to the limited individuals who have characteristics that align with those studied in the Wegovy clinical trials for CV use.
CarelonRx will manage Wegovy for CV use differently from Wegovy for weight loss. We 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. We understand that not all clients cover Wegovy as part of their weight loss benefits, and in those cases, we will review this drug to ensure evidence-based, clinically appropriate use for the CV indications that the drug is approved for.
What does this mean to clients:
- Those that cover Weight Loss Drug Class medications: These clients may see Wegovy utilization as a small number may meet the approved criteria.
- Those that do not cover Weight Loss Drug Class medications: These clients may see Wegovy utilization for the CV indication in their claims when they have not previously.
With strict clinical guidance, CarelonRx will ensure clinically appropriate use of Wegovy for CV.
If you have questions regarding these updates or have clients interested in changing weight loss drug coverage on their benefit plan, please contact your Anthem representative.