Medicare Coverage Gap: Older Americans Struggle to Obtain New Weight Loss Medications
Medicare rules prevent millions of elderly Americans from taking obesity medications that promise to help them lose weight.
However, despite their potential benefits, these injectable medications remain financially out of reach for millions of older Americans, as Medicare is currently prohibited from covering them.
As obesity rates among older adults continue to rise, a bipartisan coalition of lawmakers, alongside drugmakers, is gearing up to advocate for a change in legislation.
The decades-old law that restricts Medicare from covering new weight loss drugs, such as Wegovy and Zepbound, is being scrutinized by proponents who argue that the United States cannot afford to maintain this prohibition.
The Food and Drug Administration (FDA) has given its approval to this new class of weekly injectables, designed to mimic hormones that regulate appetites by signaling fullness between the gut and brain during meals. Studies have shown that individuals on these drugs can experience weight loss ranging from 15 to 25 percent of their body weight.
Despite their efficacy, the high cost of these drugs has limited their accessibility, primarily favoring the wealthy. Wegovy comes with a monthly price tag of $1,300, while Zepbound costs $1,000.
Changing Views on Medicare Coverage
Additionally, shortages in the supply of these drugs have further constrained access, with private insurers often not covering the medications or imposing stringent eligibility criteria.
Last month, an international study revealed a 20 percent reduction in the risk of serious heart problems, such as heart attacks, in patients using Wegovy. This finding underscores the potential health benefits that could be extended to a broader population if Medicare were to cover these medications.
However, the initial price tag of covering these drugs poses a significant challenge. Critics argue that such an investment could strain Medicare’s already unstable financial situation.
The prohibition against covering weight loss drugs was introduced in 2003 as part of a broader overhaul of Medicare’s prescription drug benefits.
Lawmakers, mindful of safety issues in the 1990s with the withdrawal of fen-phen, a now-banned anti-obesity treatment, were hesitant to bear the high costs associated with treating what was then considered a cosmetic condition. As pressure mounts and bipartisan support grows, the conversation around overturning this long standing prohibition gains momentum.
The push to include these innovative obesity drugs under Medicare coverage reflects a shifting perspective on the medical treatment of obesity and highlights the potential impact on the health and well-being of older Americans.