NEW YORK, Aug 15 (Reuters) - Older Americans are having

little success getting prescriptions for weight-loss drug Wegovy

covered by Medicare despite the federal healthcare program's

decision to pay for patients with obesity at risk of heart

disease, according to their doctors.

In interviews with Reuters, seven obesity and heart disease

specialists from various parts of the United States said their

prescriptions for the Novo Nordisk drug have been

denied repeatedly by the healthcare companies that administer

Medicare drug benefits, with some prescriptions approved only

following an appeal for each application.

One doctor said that none of the 10 or more appeals she

sends each month are granted. Two other physicians said their

success rate with appeals was between 10% and 50% for patients

with a history of heart attack or stroke.

"If there's a medication that can help reduce your risk

further and help control your symptoms and reduce

hospitalization, to have insurance say that it's not going to be

covered is problematic," said one of the physicians, Dr. Noor

Khan, a specialist in obesity and bariatric medicine at the

University of Pittsburgh Medical Center.

"I have not been able to determine the pattern of who is

getting covered and who is not - even when we have evidence of

MI (myocardial infarction, meaning heart attack) or stroke,"

added Dr. Holly Lofton of New York University Langone, a general

practitioner specializing in obesity.

Medicare, which provides medical coverage for Americans age

65 and older, is prohibited by law from paying for weight-loss

drugs or other types of so-called lifestyle medicines.

Wegovy, a weekly injection, carries a list price of more

than $1,300 per month, prompting calls from President Joe

Biden's administration and some lawmakers for Novo to lower its

price. With nearly 70% of U.S. adults considered obese or

overweight, the cost of covering it for even a fraction of those

patients would run into the billions of dollars.

Novo and rival Eli Lilly ( LLY ) are seeking to widen

insurance coverage for their weight-loss drugs, investing in

large clinical trials intended to show specific health benefits

in addition to helping people shed pounds.

The U.S. Food and Drug Administration in March approved a

new use of Wegovy for heart disease, based on clinical trials

showing a 20% reduction in heart attack, stroke or other

cardiovascular-related death.

The Centers for Medicare & Medicaid Services, the U.S.

agency that administers the program, the same month issued

guidance to health insurers to cover the drug for that use. The

agency did not immediately respond to a request for comment.

A Novo Nordisk spokesperson said the company will continue

to work with payers and policymakers to ensure that seniors

living with obesity have insurance coverage.

Two companies that manage prescription drug benefits for

Medicare patients, CVS Health's ( CVS ) Caremark and

UnitedHealth Group's Optum RX, said it is possible for

patients to access Wegovy for the cardiovascular indication, but

declined to say how many plans were covering the drug or how

many would in the future. Others did not respond to requests for

comment.

'VARIATION IN COVERAGE'

A July analysis by KFF, a non-profit that conducts health

policy research, showed that only 1% of plans for Medicare

patients offered by these middlemen covered Wegovy for heart

disease.

Juliette Cubanski, deputy director of KFF's program on

Medicare policy, said plan sponsors often wait until the start

of the calendar year to begin coverage of a newly approved

prescription drug. Cubanski said she expects more Medicare plans

to start covering Wegovy next year, although even then "we'll

see variation in coverage for this drug, just as we do for other

expensive medications."

Consultant Jeff Levin-Scherz at Willis Towers Watson, a

company that advises businesses on healthcare benefits, said

covering Wegovy this year would hurt Medicare plans margins, as

they would not have been able to adjust for the change in costs.

They may need to widen coverage even further. Lilly's

clinical trials have shown its obesity drug Zepbound can help

treat obstructive sleep apnea. Lilly is seeking FDA approval for

that use and expects the drug would then be covered by Medicare.

Novo and Lilly have also lobbied U.S. lawmakers to pass a

law allowing Medicare to cover their drugs just for obesity.

Morningstar analyst Karen Andersen said the lack of uptake

for Wegovy among Medicare plans does not seem to be affecting

Novo's sales. Soaring demand among younger Americans whose

health insurance is covered by their employer continues to

outpace supply.

Meanwhile, doctors with Medicare patients have the task of

preparing them for having their coverage rejected.

"I spend about 20 to 30 minutes creating realistic

expectations because (Medicare) has a very tight window of what

they're going to agree to pay for or not," said Dr. Kyla

Lara-Breitinger, a cardiologist at the Mayo Clinic in Rochester,

Minnesota.