New drugs are in demand to help people lose weight. But so far Medicare won’t cover them. Find out why and how that might change.
New weight-loss drugs like Ozempic are a big buzz these days, with commercials touting the pounds dropped every 5 minutes on TV, as well as celebrities crediting the medications for their new, slimmer silhouette. And there’s a good chance that someone you know has been using one of them, too.
This new class of drugs, called GLP-1, was originally developed for managing type 2 diabetes. They work by mimicking a hormone that controls blood sugar levels and appetite. These drugs make you feel more full after eating, so you eat less. Of course, less food means you lose weight – often quite a lot. And once people with diabetes started shedding pounds, the drugs became popular with people who don’t have diabetes but who wanted to drop some weight.
Right now there are four of these new drugs, all of which have to be injected:
- Ozempic was the first one. This drug is FDA approved to treat diabetes, but not approved for weight loss, even though some people are using it for that purpose anyway.
- Wegovy works much the same way as Ozempic. It’s sold in slightly different dosages and is FDA approved for weight loss, but not for diabetes.
- Mounjaro is FDA-approved to treat diabetes, but has also been used for weight loss.
- Zepbound is specifically approved for weight loss, and not for diabetes.
If you have diabetes, a Medicare prescription plan will likely cover one of the weight-loss drugs approved for diabetes, such as Ozempic. But as of March 2024, no Medicare plans cover the cost of these drugs for weight loss only. In fact, Medicare plans can’t pay for the drugs even if they wanted to. A federal law passed in 2003 prohibits Medicare from covering weight loss medications except for people with type 2 diabetes.
Americans clearly want that to change. In a recent national survey of adults aged 50 to 80, three-quarters of them said that Medicare should cover weight loss drugs. And almost two-thirds of them showed interest in taking the drugs themselves to lose weight.
One of the researchers who worked on the survey, Dr. Lauren Oshman, an obesity medicine specialist and associate professor in the University of Michigan Department of Family Medicine, told Detroit Free Press: “Some of my patients who are most severely affected by obesity and its complications are least able to access healthy food items, have time to go to a gym, have a safe place to exercise in their community. These medications really can be lifesavers for them.”
It’s no surprise that steps are being taken to allow Medicare to cover these drugs – including attempts to change the decades old federal law that prevents it. But the high cost of the drugs and safety are also considerations.
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The cost of the new drugs
Even if the law changed, one of the obstacles is that these new drugs are very expensive. Wegovy, for example, has a list price of $16,000 a year. And right now it looks like if you lose weight on a GLP-1 drug, you’ll need to stay on that drug to keep the weight off. Considering that more than 40% of adults over 60 in the United States are obese, millions of people could be given prescriptions for these drugs.
As Dr. Oshman told Detroit Free Press: “(i)t's a lot to ask health plans to cover these medicines for every patient, and at this cost, it would significantly raise the cost of health insurance and of healthcare for everyone.”
Of course, some people think there’s a possibility these drugs could actually pay for themselves, particularly for the insurance company. There are two reasons why. First, new research has shown that helping people lose weight could also help prevent health complications and hospitalizations from chronic conditions like heart disease and diabetes. That could lead to substantial savings on medical treatments and hospital stays.
Second, new evidence suggests that these drugs could help people manage other harmful behaviors, particularly around addiction. That’s because the drugs are believed to affect the brain’s pleasure and reward centers, helping people to curb addictive behaviors like drug abuse and smoking. The savings from treating these conditions could help offset the high cost of the medication.
Unfortunately, the price of the medications is currently so high that, even with all those benefits, the math doesn't justify insurance coverage.
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Are these drugs safe?
No drugs are without side effects, and GLP-1 drugs have their share. The most common side effects are nausea and vomiting, which may affect up to half of people who take the medications.
And there’s another risk for seniors. Sadly, no matter how you lose weight, you always lose muscle along with fat. Muscle loss can be even more drastic when you lose weight quickly, which is particularly dangerous, as it can increase your risk of falls and broken bones.
Most of the participants of these studies were middle-aged adults. But in studies that included seniors, they were more likely to suffer nausea, vomiting, and fatigue, and had a greater risk of osteoporosis (brittle bones). The side effects were thought to explain why people over 65 were more likely to stop taking the drugs than younger patients.
Will Medicare ever cover these drugs?
Twenty years ago, when the law that now prevents Medicare from covering these new weight loss drugs was passed, doctors and the general public had different ideas about weight. Back then, obesity was mainly thought to be caused by a lack of willpower. And it was mostly talked about as being less attractive, not as a danger to your health. Now we know that obesity is a medical condition, often partly determined by our genes, that needs treatment just like other diseases.
It was only about 10 years ago that the American Medical Association (AMA) formally recognized obesity as a disease. And only in December of 2023 that the AMA called on insurance companies, employers, and government programs like Medicare to cover obesity treatments, including new drugs.
There’s also a push in Congress to get these drugs covered. The Treat and Reduce Obesity Act would allow Medicare to cover anti-obesity medications. The Act, which has been introduced every year in Congress since 2013, currently has support from both parties.
What you can do now
Whether you want to lose 10 pounds or 100, the key right now is to work with your medical team to check your health and figure out the best approach. Even if you’ve struggled with your weight before, there may be more options you can try.
And be sure to get tested for diabetes. According to the latest numbers, 8.7 million Americans have undiagnosed diabetes. It’s important to know, because diabetes can cause serious problems when left untreated, from blindness to amputation.
If you have diabetes, Medicare may cover one of these weight loss drugs. If you don’t have diabetes, work with your medical team to make sure you don’t end up with it. Losing weight can help prevent or even cure diabetes, so talk to your doctor if you’re overweight.
How Medicare can help
If you want to lose weight, Medicare may be able to help. Some Medicare Advantage plans cover health and wellness programs like gym memberships and fitness classes. And if your BMI (body mass index) is 30 or above, Medicare will cover screening and behavior treatments for obesity and, in some cases, weight loss surgery like gastric bypass and laparoscopic banding. Medicare Part D covers Ozempic when it's prescribed to treat diabetes. Also, people with type 2 diabetes are eligible for nutritional counseling covered by Medicare. To compare plans in your area, give us a call or check out our easy-to-use Find a Plan tool.
Additional resources
- AP News: New Weight Loss Drugs are Out of Reach for Millions of Americans
- New York Times: The Risks of Taking Drugs like Ozempic When You’re Over 65
- STAT News: Cost Isn’t the Only Reason Medicare Doesn’t Cover Wegovy
- US News & World Report: Most Older Americans Think Medicare Should Cover Weight-Loss Meds
