Weight loss drugs would be covered by Medicare under new legislation

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Congress will consider changing Medicare to cover weight loss drugs in an effort “to combat the obesity epidemic.”

Senators and representatives have reintroduced the Treat and Reduce Obesity Act (TROA) to fight against preventable deaths caused by obesity. Supporters called it “bipartisan, bicameral legislation” that could help patients deal with heart disease, stroke, type 2 diabetes, and some cancers.

Sen. Tom Carper (D-Delaware) and Sen. Bill Cassidy, MD (R-Louisiana), introduced the bill in the Senate. Rep. Raul Ruiz, MD (D-California), and Rep. Brad Wenstrup, DPM (R-Ohio), introduced it in the House.

“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,” Carper said in a news release. “We cannot stand idly by while this disease continues to claim lives through related illnesses that are preventable and treatable. I’m proud of our bipartisan and bicameral legislation to open the door for Medicare to provide Americans with every available treatment and tool for reducing obesity’s physical, social and financial costs.”

“There is a clear need to address obesity,” Cassidy said in the statement. “Expanding Medicare coverage to the treatments patients need enables them to improve their health and benefits us all.”

Strong support

The legislation would expand Medicare coverage to new specialists and screenings, along with weight management medications, according to the senators.

There are at least 10 cosponsors in the Senate and a number of physician and health care organizations have endorsed it. This month, the American Gastroenterological Association (AGA) reaffirmed its support for the bill.

In patients, additional effects of obesity include metabolic dysfunction-associated fatty liver disease, formerly called nonalcoholic fatty liver disease, and gastroesophageal reflux disease. Obesity affects 93 million Americans and could have an economic effect up to $4.3 trillion a year if current trends continue, according to AGA.

“Expanding access and improving early intervention and treatment options will help patients overcome these diseases and live healthier lives,” ADA Government Affairs Committee Chair Rotonya Carr, MD, said in a statement. “Because many private insurance companies model their health benefits to reflect Medicare, the passage of TROA could lead to improved obesity care options for all Americans.”

Public support for paying

The effectiveness of the newest weight loss drugs has created a sensation among physicians and patients in U.S. health care. But they aren’t cheap – pharmaceutical company Novo Nordisk A/S notes the list price per package is $1,349.02 for Wegovy (semaglutide 2.4mg).

This month, KFF published its “KFF Health Tracking Poll July 2023: The Public’s Views Of New Prescription Weight Loss Drugs And Prescription Drug Costs.” The survey found 80% of adults say insurance companies should cover the cost of weight loss drugs for adults who are overweight or obese. More than half of adults (53%) said health insurance should pay for the drugs for anyone who wants to lose weight, and 50% of respondents said they support insurance coverage for the drugs even if premiums increase for everyone.

There is strong interest in the new drugs but prescriptions for weight loss are relatively rare – 87% of respondents said they have never used a prescription drug to shed pounds.

More from Wegovy

The legislation remained pending as Novo Nordisk on Aug. 8 announced study results that Wegovy reduced the risk of major adverse cardiovascular events by 20% in adults with overweight or obesity and established cardiovascular disease. It was the first antiobesity medication to demonstrate a cardiovascular benefit.