Weight loss meds raise new cost questions for Medicare

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

Now 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, the lawmakers say the United States cannot afford to keep a decades-old law that prohibits Medicare from paying for new weight loss drugs on the books.

The Food and Drug Administration has in recent years approved a new class of weekly injectables including 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.

But cost of the drugs 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.

Rep. Brad Wenstrup, R-Ohio, introduced legislation with Rep. Raul Ruiz, D-Calif., this year that would allow Medicare to cover the now-forbidden anti-obesity drugs, therapy, nutritionists and dieticians.

“For years there was a stigma against these people, then there was a stigma about talking about obesity,” Wenstrup said in an interview. “Now we’re in a place where we’re saying, this is a health problem, we need to deal with this.”

He believes the intervention could alleviate all sorts of ailments associated with obesity that cost the system money.

“The problem is so prevalent,” Wenstrup said. “People are starting to realize you have to take into consideration the savings that comes with better health.”

A Vanderbilt University analysis this year put an annual price of about $26 billion on anti-obesity drugs for Medicare if just 10% of the system’s enrollees were prescribed the medication.

Other research, however, shows it could also save the government billions, even trillions over many years, because it would reduce some of the chronic conditions and problems that stem from obesity.

An analysis this year from the University of Southern California’s Schaeffer Center estimated the government could save as much as $245 billion in a decade, with the majority of savings coming from reducing hospitalizations and other care.

Last year, about 40% of the nearly 66 million people enrolled in Medicare had obesity. That roughly mirrors the larger U.S. population, where 42% of adults struggle with obesity, according to the Centers for Disease Control and Prevention.

Pharmaceutical companies also are readying for a lobbying blitz next year with the drugs getting the OK from the FDA to be used for weight loss.

“Americans should have access to the medicines that their doctors believe they should have,” Stephen Ubl, the president of the lobbying group, Pharmaceutical Research and Manufacturers of America, said on a call with reporters last week. “We would call on Medicare to cover these medicines.”

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