- Medicare is barred under a 2003 law from paying for weight-loss medications like Wegovy.
- Lawmakers on Thursday reintroduced a bill that would expand Medicare coverage to the drugs.
A major roadblock has long stood in the way of older Americans getting treatments for obesity: Medicare.
The federal program that provides health coverage for people 65 and older is prohibited by a 2003 law from paying for weight-loss drugs such as Wegovy — the expensive injection that's taken the world by storm. And without insurance, most people can't afford the shots, which can cost upwards of $1,000 a month.
But US lawmakers on Thursday took steps to broaden access to weight-loss treatment for seniors. They introduced a bill, titled The Treat and Reduce Obesity Act of 2023, in the Senate and House of Representatives that would allow Medicare to pay for weight-loss drugs for the first time.
Previous versions of the bill have languished in Congress for more than a decade. This time, though, the proposal is being reintroduced amid an avalanche of demand for new and effective weight-loss drugs and a lobbying blitz by the drugmakers behind them.
Should the legislation become law, the implications could extend beyond seniors. Medicare coverage might prod other health insurers to pay for weight-loss medications, as private health plans tend to follow Medicare's lead. About 65 million people are enrolled in Medicare, while more than 150 million people get health coverage from an employer.
"With obesity rates on the rise in our country, we must do more to combat this epidemic head on. Too many of those in need are being denied care because of the high cost of medications or inaccessible treatment options," Democratic Sen. Tom Carper said in a press release.
Carper reintroduced the bill along with Republican Sen. Bill Cassidy and Representatives Raul Ruiz, a California Democrat, and Brad Wenstrup, a Republican from Ohio.
Lawmakers have balked at the cost of weight-loss drugs
About 42% of Americans have obesity, a figure that has risen drastically in the last two decades, and about the same amount of older folks have the condition.
A new class of weight-loss injections known as GLP-1 agonists — drugs such as Novo Nordisk's Wegovy and Ozempic, and Eli Lilly's Mounjaro — have proven effective at helping people lose a significant amount of weight. But steep price tags and a dearth of insurance coverage have kept the drugs from getting to many people who need them.
Lawmakers have balked at the high cost of covering treatment for a condition that historically was seen as cosmetic. One analysis by Vanderbilt University researchers in March estimated that if just 10% of Medicare beneficiaries were treated with Wegovy, the cost to the program would total $26.8 billion a year and premiums for drug plans would increase.
Still, lawmakers are facing pressure from drugmakers, obesity doctors, patients, and advocacy organizations that argue obesity should be treated like any other chronic disease, regardless of the cost.
Novo Nordisk and Eli Lilly, which have seen their sales soar as Americans clamor for their weight-loss medications, stand to gain even more if Medicare expands coverage, so they're lobbying Congress to make moves. Novo Nordisk spent $4.6 million on lobbying in 2022, the Wall Street Journal reported.
Chris Gallagher, a lobbyist and policy consultant for the Obesity Action Coalition, which advocates for obesity treatment, said the bill has a better chance of progressing during this Congress than in the past. That's in part because the agency overseeing the health plan for millions of federal employees clarified that it couldn't exclude anti-obesity medications from coverage. It wouldn't be a good look for lawmakers to deny Medicare beneficiaries a benefit that federal employees have, he said.
The buzz in the public around the drugs also helps.
"Clearly the excitement about the new medications that are out and in the pipeline, their great efficacy, is also front and center," he said.