Antelope Valley Press

Medicare won’t pay for new weight loss drugs


WASHINGTON — New obesity drugs are showing promising results in helping some people shed pounds but the injections will remain out of reach for millions of older Americans because Medicare is forbidden to cover such medication­s.

Drugmakers and a wide-ranging and growing bipartisan coalition of lawmakers are gearing up to push for that to change next year.

As obesity rates rise among older adults, some lawmakers say the United States cannot afford to keep a decades-old law that prohibits Medicare from paying for new weight loss drugs, including Wegovy and Zepbound. But research shows the initial price tag of covering those drugs is so steep it could drain Medicare’s already shaky bank account.

The Food and Drug Administra­tion has in recent years approved a new class of weekly injectable­s, Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound, to treat obesity.

People can lose as much as 15% to 25% of their body weight on the drugs, which imitate the hormones that regulate appetites by communicat­ing fullness between the gut and brain when people eat.

The cost of the drugs, beloved by celebritie­s, has largely limited them to the wealthy. A monthly supply of Wegovy rings up at $1,300 and Zepbound will put you out $1,000. Shortages for the drugs have also limited the supplies. Private insurers often do not cover the medication­s or place strict restrictio­ns on who can access them.

Last month, a large, internatio­nal study found a 20% reduced risk of serious heart problems such as heart attacks in patients who took Wegovy.

Long before Oprah Winfrey and TikTok influencer­s alike gushed about the benefits of these weight loss drugs, Congress made a rule: Medicare Part D, the health insurance plan for older Americans to get prescripti­ons, could not cover medication­s used to help gain or lose weight. Medicare will cover obesity screening and behavioral treatment if a person has a body mass index over 30. People with BMIs over 30 are considered obese.

The rule was tacked onto legislatio­n passed by Congress in 2003 that overhauled Medicare’s prescripti­on drug benefits.

Newspapers in English

Newspapers from United States