Wegovy – Getting to the Heart of the Matter
On March 8, 2024, the U.S. Food and Drug Administration (FDA) announced its approval of Wegovy (semaglutide) injections for a new indication in addition to weight loss. Their release states, “to reduce the risk of cardiovascular death, heart attack and stroke in adults with cardiovascular disease and either obesity or overweight. Wegovy should be used in addition to a reduced calorie diet and increased physical activity. Cardiovascular disease is a group of diseases of the heart and blood vessels.”
As of this writing, it is unclear if and which payers will cover the FDA approval expansion for cardiovascular diseases in those patients with diabetes. Wegovy is not approved at this juncture for treatment of heart disease alone.
According to the CDC, heart disease is the leading cause of death in the United States.
- About 695,000 people in the United States died from heart disease in 2021—that’s 1 in every 5 deaths.
- Heart disease cost the United States about $239.9 billion each year from 2018 to 2019. This includes the cost of health care services, medicines, and lost productivity due to death.
What dosage or packaging options and NDC codes are available for Wegovy?
Wegovy is available in five strengths and the increased strengths are administered during the initiation, escalation, and maintenance dosing schedule. The table below provides the current dosage options, NDC package codes, and labeler names for Wegovy from the FDA website.
| Package name | NDC Package code | Labeler Name |
|---|---|---|
| Wegovy® 0.25 MG | 0169-4525-14 | Novo Nordisk |
| Wegovy® 0.25 MG | 0169-4525-94 | Novo Nordisk |
| Wegovy® 0.5 MG | 0169-4505-14 | Novo Nordisk |
| Wegovy® 1 MG | 0169-4501-14 | Novo Nordisk |
| Wegovy® 1.7 MG | 0169-4517-14 | Novo Nordisk |
| Wegovy® 2.4 MG | 0169-4524-14 | Novo Nordisk |
| Wegovy® 0.25 MG | 50090-5824-0 | A-S Medication Solutions |
How can your plan assess prescribing and filling activity for Wegovy using Fraud Scope?
Based on the current approved guidance for Wegovy from the FDA, which includes diabetes, obesity, and cardiovascular disease, health plans should expect prescriptions from a wider range of peer groups, such as cardiologists and endocrinologists. Health plans can easily assess the prescribing or filling traffic for Wegovy either at the claim or aggregate level using the Fraud Scope Query toolkit filters and charting options as follows:
Query Builder: Pharmacy, Claims, Prescribing or Filling
Filter: Drug Label, Exact = Wegovy
Filter: Provider Payment Received, Within this range = Minimum $0.01
After receiving the results, use the Show Chart option to plot any of the available pharmacy claims fields to display prescription counts or payments for any patient, prescribing or filling identity. Health plans should consider reviewing, even at low volumes, prescribing providers whose specialty or taxonomy is unexpected for the covered conditions of Wegovy, which may suggest the prescription is for an unapproved treatment or condition.
Additionally, the Show Map option allows users to review the geographic distribution of the Wegovy claims for patients, prescribers, and filling entities.
Query Builder: Pharmacy, Aggregates, Prescribing or Filling, Drug Label
Filter: Drug Label, Exact = Wegovy
Filter: Provider Payment Received, Within this range = Minimum $0.01
After receiving the results, use the Show Chart option to plot any of the available aggregate pharmacy fields to identify the prescribing specialty with the highest claim counts or overall payments, or which filling providers have the highest claim composition for Wegovy.
References:
- U.S. Food and Drug Administration
- American Medical Association
https://newsroom.uw.edu/video-library/wegovy-approved-for-heart-disease-what-it-means
- The New England Journal of Medicine
- Center for Disease Control
https://www.cdc.gov/heartdisease/facts.htm
- U.S. Food and Drug Administration – National Drug Code Directory – Wegovy
https://www.accessdata.fda.gov/scripts/cder/ndc/dsp_searchresult.cfm
