Obesity Drugs Show Promise in Weight Loss, but Medicare Cannot Cover Them
New obesity drugs, such as Wegovy and Zepbound, are proving to be effective in helping people lose weight. However, Medicare is currently prohibited from covering these medications, leaving millions of older Americans without access. Drugmakers and a bipartisan coalition of lawmakers are preparing to advocate for a change in Medicare coverage next year.
The Cost and Impact of Covering Obesity Drugs
While the efficacy of these weight loss drugs is promising, the initial price tag for covering them is steep and could strain Medicare’s already fragile finances. Medications like Wegovy and Zepbound, which are favored by celebrities, come with a hefty price tag of $1,300 and $1,000 per month, respectively. Additionally, shortages of these drugs have limited their availability. Private insurers also often do not cover them or impose strict restrictions on access.
The Case for Medicare Coverage
Lawmakers argue that as obesity rates continue to rise among older adults, Medicare cannot afford to uphold a decades-old law that prevents coverage for weight loss drugs. These medications imitate the hormones that regulate appetite and have shown the potential for significant weight loss (15% to 25% of body weight). Last month, a study found a 20% reduced risk of serious heart problems in patients who took Wegovy.
The Historical Ban on Medicare Coverage
The ban on Medicare coverage for weight loss drugs was implemented in 2003 as part of legislation overhauling Medicare’s prescription drug benefits. Lawmakers were reluctant to cover the high costs of drugs for a condition historically seen as cosmetic. Safety concerns surrounding previous anti-obesity treatments also influenced their decision. However, Medicaid does cover these drugs in some areas, albeit with fragmented access.
The Potential Health and Financial Benefits
New studies suggest that weight loss drugs could have far-reaching benefits beyond slimming down patients. Lawmakers have introduced legislation to allow Medicare coverage for anti-obesity drugs, therapy, nutritionists, and dieticians. The intervention could potentially alleviate various health conditions associated with obesity and save the healthcare system money. Currently, around 40% of Medicare enrollees suffer from obesity, mirroring the broader US population.
The Price Tag Debate
The upfront cost of lifting the ban on Medicare coverage remains a significant challenge. Some research suggests that offering weight loss drugs could lead to Medicare’s bankruptcy, with an estimated annual cost of $26 billion if 10% of enrollees were prescribed the medication. However, other studies indicate potential savings of up to $245 billion over a decade by reducing hospitalizations and other care associated with obesity. The Congressional Budget Office acknowledges the difficulty in estimating the cost and calls for further research on the topic.
The Importance of Comprehensive Obesity Treatment
Doctors emphasize that weight loss drugs are just one part of an effective strategy for treating obesity. Behavioral intervention, health and diet education, and surgery are often combined to provide comprehensive care. A blanket prohibition on anti-obesity medication under Medicare limits treatment options and perpetuates health disparities.
Efforts to Change Medicare Coverage
Lawmakers have introduced various bills over the past decade to permit Medicare coverage of weight loss drugs. This year’s bill has garnered support from more than 60 lawmakers across the political spectrum. Passage of the bill is a top priority for Rep. Brad Wenstrup and Sen. Tom Carper before their retirement next year. Pharmaceutical companies are also preparing to lobby for Medicare coverage of these drugs, highlighting the importance of patient access to necessary medications.
Shifting Momentum Towards Coverage
Advocates for Medicare coverage of obesity drugs have been pushing for this change for years. Now, with growing evidence of the drugs’ ability to prevent strokes, heart attacks, and even death, the conversation has shifted from whether obesity treatment is worthwhile to figuring out how to make it economically viable. Many believe that change is inevitable.
