CMS: Step Therapy, Quantity Limits Can Be Used In Wegovy Heart Disease Coverage

By Luke Zarzecki / March 27, 2024 at 4:15 PM
FDA’s recent approval of Novo Nordisk’s Wegovy for cardiovascular treatment quickly paved the way for CMS coverage of the expensive weight-loss drug for the new indication, but CMS also told Medicare and Medicaid plans they can limit their costs by imposing prior authorization, step therapy and quantity limits -- and how Medicaid agencies will approach coverage is currently being decided by each state. “Utilization management tools such as prior authorization, step therapy, and quantity limits that are approved by the...


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