This FAQ addresses common questions endocrinologists may have for prescriptions (Drug, Devices) , Prior Authorization, current guidelines, etc.
How to obtain Prior Auth for Wegovy for CVD Risk Reduction?
The US Food and Drug Administration (FDA) approved Wegovy® (semaglutide) in March 2024 to reduce the risk of cardiovascular disease (CVD) in adults who are overweight or obese and have heart disease.
The approval is based on data from a five-year clinical trial that found that patients taking Wegovy® in addition to standard care had a 20% lower risk of heart attack, stroke, and CVD death
SELECT Trial: Nature Medicine 30, 2049-2057 (2024): In this 4-year study, semaglutide showed a 20% reduction in major adverse cardiovascular events in 17,604 adults with preexisting cardiovascular disease, overweight or obesity, without diabetes
The FDA also recommends that Wegovy® be used in conjunction with a reduced calorie diet and increased physical activity.
Medicare does not cover semaglutide (Wegovy®) for obesity without diabetes, but will cover for overweight/obesity and CVD disease
How to obtain approval for Wegovy® in patients with overweight/obesity AND high CVD risk:
1) Is documentation being provided to confirm that the patient has had a prior myocardial infarction? Medical documentation specific to your response to this question must be attached to this case or your request could be denied. Documentation may include, but is not limited to, chart notes, prescription claims records, prescription receipts, and/or other information.
2) Is documentation being provided to confirm that the patient has had a prior stroke? Medical documentation specific to your response to this question must be attached to this case or your request could be denied. Documentation may include, but is not limited to, chart notes, prescription claims records, prescription receipts, and/or other information.
3) Is documentation being provided to confirm that the patient has a history of symptomatic peripheral arterial disease as evidenced by one of the following: (1) intermittent claudication with ankle-brachial index less than 0.85, or peripheral arterial revascularization procedure, or amputation due to atherosclerotic disease? Medical documentation specific to your response to this question must be attached to this case or your request could be denied. Documentation may include, but is not limited to, chart notes, prescription claims records, prescription receipts, and/or other information.
