Millions of elderly Americans cannot afford new weight-loss medications because Medicare will not cover them

Although new anti-obesity injections are helping some people lose weight, millions of older Americans will not be able to afford them since Medicare is not allowed to pay for these kinds of treatments.

A broad and expanding bipartisan coalition of politicians, together with drugmakers, are preparing to fight for a change in that next year.

Some lawmakers argue that the United States cannot afford to maintain a decades-old regulation that prevents Medicare from paying for new weight loss medications like Wegovy and Zepbound, given the growth in obesity rates among older persons. However, studies reveal that the initial cost of covering certain medications is so high that it may break Medicare’s already precarious financial situation.

Examining the argument for and against Medicare’s coverage of medications for obesity:

In order to manage obesity, the Food and Drug Administration has just approved a novel class of weekly injectables, which includes Zepbound from Eli Lilly and Wegovy from Novo Nordisk.

With the medications, people can lose up to 15% to 25% of their body weight. The drugs work by mimicking the hormones that control hunger by sending signals from the gut to the brain whenever someone eats.

Millions of elderly Americans cannot afford new weight-loss medications because Medicare will not cover them

Celebrity-loved medications are expensive, and only the wealthy can afford them. Zepbound will cost you $1,000 and a monthly supply of Wegovy will cost you $1,300. The supplies have also been restricted due to medicine shortages. Private insurance companies frequently deny coverage for the drugs or impose stringent limitations on who is able to obtain them.

A recent large-scale multinational study indicated that patients taking Wegovy had a 20% lower risk of developing major heart problems, including heart attacks.

Congress passed a law long before celebrities like Oprah Winfrey and TikTok influencers gushed about the advantages of these weight-loss pills: Medicare Part D, the prescription drug insurance programme for senior citizens, could not pay for pharmaceuticals meant to aid in weight growth or loss. Medicare will pay for behavioural therapy and obesity screening if the patient’s BMI is higher than thirty. Obese people are those whose BMI is greater than thirty.

The provision was added to a 2003 piece of legislation that changed Medicare’s prescription drug benefits and was passed by Congress.

Legislators objected to having to pay exorbitant prescription prices for a problem that was once thought to be cosmetic. They were also still remembering the safety issues from the 1990s involving the anti-obesity medication known as fen-phen, which forced its removal from the market.

In certain places, Medicaid—a state-federal collaboration programme for the underprivileged—does pay for the medications, but access is uneven.

New research reveals the medications’ benefits go beyond just helping users lose weight.

This year, Rep. Brad Wenstrup of Ohio and Rep. Raul Ruiz of California presented legislation that would permit Medicare to pay for the anti-obesity medications, therapy, nutritionists, and dietitians that are currently prohibited.

In an interview with The Associated Press, Wenstrup stated, “For years there was a stigma against these people, then there was a stigma about talking about obesity.” “At this point, we’re saying that this is a health issue that needs to be addressed.”

Leave a Comment