Should Insurance Cover Obesity Medications? Older Adults Weigh In

Most older adults support Medicare covering weight medications but resist premium hikes.

Highlights:

Older adults support Medicare coverage for weight management medications
Only 30.2% approve of higher premiums to ensure coverage
New policies could expand access without increasing costs

Obesity is a widespread public health concern, with nearly 50% of U.S. adults projected to be obese by 2030. For older adults, managing weight is especially important due to the increased risk of obesity-related conditions like diabetes, heart disease, and sleep apnea. A recent survey involving 2,657 U.S. adults aged 50 to 80 years revealed significant interest in weight management medications (WMMs) and mixed opinions on insurance coverage ().

The study found that 35.1% of participants were interested in using WMMs. However, among those with a BMI of 30 or greater (classified as obese), the interest surged to 59.1%. Notably, while most participants (75.7%) favored Medicare coverage for these medications, only 30.2% were willing to pay higher Medicare premiums to guarantee coverage.

Weight Loss Drugs (Diet Pills)
Diet pills are medicines that help control or reduce weight. Diet pills are otherwise know as weight loss drugs or anti-obesity medications.

‘Did You Know?
75% of older adults want Medicare to cover weight medications, yet only 30% are willing to pay higher premiums for it! #WeightManagement #MedicareCoverage #medindia’

Why Weight Management Medications Matter for Older Adults

Weight management medications are increasingly recognized as effective tools in combating obesity. Since 2012, the FDA has approved several new and more effective WMMs, including ().

Semaglutide (2021) and tirzepatide (2023) – part of the incretin mimetic class, which helps reduce appetite and regulate blood sugar.
Liraglutide (2014) – another incretin mimetic that promotes weight loss.
Phentermine-topiramate (2012) and bupropion-naltrexone (2014) – older medications still used for weight management.

These drugs have shown clinically significant weight loss and improved health outcomes, making them valuable options for older adults struggling with obesity.

Clinical Trial Finds Weight Loss Drug Reduces Heart Failure Risk
Tirzepatide may reduce hospitalizations, improve symptoms, and decrease death risks in heart failure patients, offering new hope for those with preserved ejection fraction.

The Coverage Dilemma

The survey highlighted a clear preference for insurance coverage of WMMs among older adults. Majority of those surveyed believed that health insurance, including Medicare, should cover these medications. However, when it came to paying more in Medicare premiums, support dipped considerably ().

This gap between desiring coverage and accepting higher costs reflects a broader challenge in healthcare: balancing accessibility with affordability. This indicates that while older adults recognize the importance of coverage, they are hesitant to bear the financial burden.

Insurance Coverage for Weight Medications

Obesity - Causes, Symptoms, Diagnosis, Complications, Treatment
Obesity is a condition where there is excess accumulation of body fat which poses a risk to the health of the individual. It can affect children and adults.

The Policy Debate: Should Medicare Cover Weight Loss Drugs?

Currently, Medicare Part D does not cover most WMMs due to a statutory exclusion preventing coverage for medications used for weight management. However, the Treat and Reduce Obesity Act aims to change this. If passed, it would mandate Medicare coverage for obesity medications, recognizing obesity as a disease rather than a cosmetic concern.

Estimates show that covering semaglutide for 10% of Medicare beneficiaries with obesity could cost around $26.8 billion, accounting for 18% of Medicare Part D net spending. While costly, advocates argue that covering WMMs could reduce long-term healthcare expenses by preventing obesity-related complications.

9 Facts on Obesity
Obesity is a growing global health problem. Obesity is defined as abnormal or excessive fat accumulation that may damage your health.

Weighing the Benefits and Costs

The growing interest in WMMs among older adults reflects their struggle with obesity and the desire for effective treatment options. However, the reluctance to pay higher premiums highlights the challenge of balancing health benefits with financial concerns.

As obesity rates continue to climb, policymakers will need to consider whether expanding Medicare coverage for WMMs is a cost-effective strategy to improve the health and quality of life of older adults.

"Although access to weight management medications is growing, it could still play a larger role in supporting healthier aging."

References:

Older Adults' Views on Insurance Coverage for Weight Management Medications - (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831877)
Most older adults want insurance to cover obesity drugs and many want to use them - (https://www.michiganmedicine.org/health-lab/most-older-adults-want-insurance-cover-obesity-drugs-and-many-want-use-them)
FDA Approves New Medication for Chronic Weight Management - (https://www.fda.gov/news-events/press-announcements/fda-approves-new-medication-chronic-weight-management)

Source-Medindia