Medicare Beneficiaries Need Weight Loss Drugs, but Multiple Hurdles Stand in Their Way
Obesity remains an epidemic within the United States, and the CDC reports that approximately 42% of adults aged 60 years or older have obesity. For those with type 2 diabetes, injectable weight loss drugs like Ozempic (semaglutide) or Mounjaro (tirzepatide), in conjunction with dietary changes and exercise, can lead to healthy and sustainable weight loss. However, cost is a barrier for many; Ozempic and Mounjaro cost tens of thousands of dollars per year for those with no insurance coverage. Medicare Part D does cover the cost of Ozempic and Mounjaro, but only for those who have already been diagnosed with type 2 diabetes. For those who struggle with weight but have not yet developed type 2 diabetes, the drug remains financially inaccessible.
This lack of coverage has raised concerns from both older adults and their physicians. On July 20th of this year, four U.S. senators collaborated to reintroduce the Treat and Reduce Obesity Act (TROA) with support from an additional 10 senators. The bill seeks to expand coverage for “medications and behavioral therapies that would help [older adults] live a healthier and longer life.” A recent KFF Health News article cited estimated costs of such a benefits expansion, stating that costs to cover brand-name weight loss drugs for all obese Medicare beneficiaries would exceed $100 billion dollars. The article also brings up questions about the drug’s acceptability for use in the older adult population, citing a lack of adequate clinical trials for this age group. The fate of TROA and potential changes to Ozempic and Mounjaro coverage remain to be seen.