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Medicare Part D Extends Coverage of Obesity Treatments for New Indication

Obesity medication is now within reach for Medicare and Medicaid patients – some of them, at least.

The Centers for Medicare and Medicaid Services will begin covering anti-obesity medications for people living with obesity who have an established cardiovascular disease and are at risk of experiencing a heart attack or stroke. In March, the Food and Drug Administration approved Wegovy for a new indication that includes its use for reduction of the risk of major adverse cardiovascular events. Many private payers are expected to follow suit and expand coverage.

The agency’s decision is a crucial step forward. But many patients with obesity still won’t be able to access the medication.

Coverage Gaps Leave Some Patients in Limbo

More than 40% of Americans over 60 have obesity.

New treatments known as GLP-1 agonists have been approved by the FDA for obesity, cardiovascular risk and diabetes. Medicare does not, however, cover the drugs for obesity alone.

Health plans point to these medications’ high list prices as rationale for restricting access. But the drugs’ expense pales in comparison to the $1.4 trillion Americans spend on direct and indirect costs from obesity.

Obesity is a root cause or complicating factor of the diseases that disproportionately kill Americans, including cancer, heart disease, infection, stroke, diabetes and cirrhosis. Treating obesity as a chronic condition, rather than stigmatizing or shaming, can be revolutionary for patients and providers.

Policy Solutions

Bipartisan federal legislation, The Treat and Reduce Obesity Act, would redefine how Medicare handles obesity.

Under the bill, Medicare Part D would cover obesity medications without waiting for another serious comorbidity to make patients eligible. By expanding access, policymakers could finally give Medicare beneficiaries the chance to get their chronic condition – and their lives – back under control.

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