US Medicare announced on Monday that it will, for the first time, begin covering selective GLP-1 class weight-loss drugs starting July 1, including the injectable semaglutide produced by Novo Nordisk A/S. This means tens of millions of Medicare beneficiaries will have the opportunity to receive reimbursement for these highly sought-after medications. Boosted by this news, shares of Novo Nordisk A/S rose approximately 0.6% in Monday's trading session.
According to the final guidance issued by the Centers for Medicare & Medicaid Services, this coverage applies to patients diagnosed with obesity, defined as those with a body mass index of 30 or higher. Prior to this, Medicare only covered GLP-1 drugs for the treatment of diabetes, while drugs used solely for weight loss were explicitly excluded from coverage by federal law. This policy adjustment marks the first time since Medicare's inception that weight-loss drugs have been included in the standard reimbursement system.
Analysts note that this policy change will open up a significant market opportunity for GLP-1 drug manufacturers such as Novo Nordisk A/S and Eli Lilly. Currently, approximately 42 million Medicare beneficiaries in the US are classified as having obesity, with around 10 million considered eligible for pharmacological treatment. Investment bank Morgan Stanley previously estimated that the annual sales of the US weight-loss drug market could reach $50 billion by 2030, and Medicare's coverage decision is expected to further expand this market potential.
However, this coverage will come with strict eligibility restrictions and cost-control measures. According to the regulations, patients must undergo intensive behavioral therapy before using the drugs, the duration of drug use is generally limited to no more than two years, and there is a monthly reimbursement price cap of $750. The Centers for Medicare & Medicaid Services stated that these restrictions are intended to ensure appropriate use of the medications and control program expenditures.
Novo Nordisk A/S welcomed Medicare's decision, stating it will help more patients with obesity access evidence-based treatment options. The company also indicated it will continue to collaborate with payers to ensure the accessibility and affordability of its drugs. Eli Lilly has not yet issued a public response. Some observers believe this move may prompt other commercial insurance companies to follow suit, thereby further expanding the coverage of weight-loss drugs.
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