Medicare cannot cover weight loss drugs, but lawmakers are trying to change that
Obesity advocates, drugmakers, and lawmakers are pushing for Medicare, the federal healthcare program, to cover new weight-loss drugs. The law categorized weight loss medication alongside erectile dysfunction, hair loss, and fertility treatments in 2003, but Ozempic can change that.
Continue reading to learn more about the news below.
Medicare should cover weight-loss medication
This federal healthcare program covers 65 and older adults. Medicare is prohibited from covering a group of new weight loss drugs. These new medications can range from $900 to $1,300 per month. If 10% of beneficiaries took Ozempic for type II diabetes and Wegovy for weight loss, Medicare expenditure might be up to $28.6 billion, according to an estimate.
The drugmakers are pushing for Medicare to cover these medications and boost their sales altogether. Semaglutide, Pfizer, and tirzepatide are all lobbying for the program to cover obesity medications. Likewise, lawmakers advocating for the program to cover the new medications are trying to reduce taxpayers’ costs.
These advocates argue that obesity isn’t a lifestyle program but rather a treatable disease. Getting this coverage can allow more Americans to access weight-loss medications, given that more insurers cover these drugs.
$100 billion weight-loss medication market: what’s the future?
Increasing Medicare coverage for these game-changer drugs could change the weight-loss and obesity landscape in America. More private insurance companies may follow suit if the program covers these medications.
Congress staff said that it’s unlikely that the program will expand its coverage. Chris Gallagher, who is a policy consultant for an obesity treatment advocacy organization, expressed his optimism.
However, insurance coverage of weight-loss drugs will take place piece-by-piece until more insurers cover these medications. Employers are still struggling to cover medication. They play an important role in the coverage of 150 million Americans. Some cover healthcare costs while others don’t.
Medicaid, another healthcare coverage program for low-income groups, can cover these drugs, but less than 20 states can do so.
Whether new regulation will come into effect or not, other Americans will go to Mexico, Canada, and online pharmacies for weight-loss drugs at cheaper prices.