New obesity drugs are showing successful results in helping some people lose weight. However, Medicare is currently prohibited from covering these injection medications. Lawmakers and drug manufacturers are eager to advocate for a change in policy next year. These medications, known as Wegovy and Zepbound, have initially proven to be expensive and present a significant strain on Medicare’s finances, as revealed by research. As the debate continues about whether and how Medicare should cover obesity drugs, it’s essential to understand what these drugs are and how they work. Implications regarding Medicare coverage of weight-loss drugs, and calls for changes in coverage, have led to a shift in the conversation around the potential benefits of these medications.
The Food and Drug Administration has recently approved new weekly injectable drugs, Wegovy and Zepbound, for obesity treatment. These drugs have the potential to help individuals lose as much as 15% to 25% of their body weight. However, affordability has become a major issue for the majority of older Americans enrolled in Medicare.Rates of obesity among older adults persist in rising and, with more prominent health concerns, some lawmakers believe it is time to revise the long-standing Medicare prohibition. Evidence also suggests that these drugs could lead to significant health savings for the system.
The root of the problem goes back to a law passed by Congress in 2003. Lawmakers have long been hesitant to cover the costs of treating a condition that is often perceived as cosmetic. However, as recent studies show, the benefits of these anti-obesity drugs are no longer widely regarded only in the context of slimming down. The conversation has shifted, with the potential health cost savings now being considered. Last year, approximately 40% of nearly 66 million Medicare enrollees had obesity.
Medicare currently covers surgical procedures to treat medical complications related to obesity. Researchers believe this exception may serve as a blueprint for expanding coverage to include the new drugs. However, the substantial initial cost to Medicare is a significant obstacle to lifting the current rule. While some studies estimate hundreds of billions of dollars in potential future savings, there is also concern over the significant upfront costs to Medicare.
There is growing support from both sides of the aisle for the expansion of Medicare coverage to include weight loss drugs, creating a potential bipartisan solution. Lawmakers are focused on the potential cost savings and positive health implications and are eager to push for this change in policy before their retirement next year. Pharmaceutical companies are also gearing up for a lobbying effort aimed at getting the required approval from the FDA for weight loss drugs and ultimately pushing for Medicare to cover these medications.
Researchers and doctors are referring to weight loss drugs as part of the most effective strategies to treat obesity. They advocate for changes to Medicare’s policies in order to allow broader access to weight loss drugs for Medicare beneficiaries, understanding that the current rules perpetuate health disparities. As the debate continues, it remains to be seen how Medicare’s coverage of obesity drugs may evolve and impact millions of older Americans.
