FRANKFURT, March 22 (Reuters) - Germany's public health

insurance scheme can cover certain patients with a risk of heart

disease or strokes to take the weight-loss Wegovy drug, a big

boost for Novo Nordisk's efforts to convince governments of its

wider medical benefits.

The European Union's drug regulator has been reviewing wider

use of the highly popular weight-loss drug Wegovy to include

reducing the risk of strokes and heart attacks, adding to the

previously-approved use to tackle obesity.

Guidance posted online late on Thursday by health agency

G-BA for Europe's largest national drug market said that

regulation banning Germany's health insurance system from paying

for weight-loss drugs such as Wegovy would not apply in the case

of other approved uses of the weekly injection.

Novo Nordisk has been pushing to widen insurance

coverage in Europe by showing health benefits beyond weight

loss.

In a similar ruling on Thursday, the U.S. agency overseeing

the Medicare programme for the elderly said that heart patients

under its remit would be covered for Wegovy as long as it is

prescribed to reduce their risk of heart attacks and strokes.

U.S. Medicare prescription drug plans administered by

private insurers currently also cannot cover drugs for obesity.

The EU's review is based on a trial known as Select, which

showed that the drug can reduce the risk of heart attacks,

strokes or death from heart disease by 20% in certain overweight

people who have already had serious cardiovascular problems.

G-BA formally confirmed that Germany's statutory health

plans are not to pay for Wegovy when prescribed for weight-loss,

but added a caveat.

"In case that the requested extension of approval is

granted, it should be noted for clarity that the use of Wegovy

to reduce the risk of cardiovascular events after prior

cardiovascular disease ... is not subject to the regulation,"

the committee said in its guidance.

The guidance by G-BA and Medicare are likely to have

repercussions beyond the use of Wegovy because Novo's rival Eli

Lilly ( LLY ) has also been running trials to show additional

health benefits of its highly effective weight-loss drug

Mounjaro, also known as tirzepatide.

G-BA is a committee made up of representatives of

physicians, medical insurances and hospitals, which plays a key

government-assigned role in setting standards for treatment and

financial coverage.

The German policy declaring weight-loss drugs lifestyle

products that people need to pay for themselves affects

statutory health plans overseen by the state that cover 90% of

people in Germany.

Many other European countries have kept a restrictive stance

when it comes to health system coverage.

Ballooning demand for Wegovy, and for diabetes drug Ozempic

which is based on the same active ingredient, has more than

doubled Novo's share price over the past two years but it has

also overwhelmed the company's ability to ramp up production of

the weekly injections.

For now, people paying for slimming drugs out of their own

pockets have been a major driver of Novo and Lilly's sales

growth but insurers in the public sector could underpin the

longer-term momentum, analysts have said.