A 2003 law prohibits Medicare Part D from covering weight loss drugs, but if that changes, this class of popular medications could cost Medicare tens of billions, the KFF reported May 18.
GLP-1 treatments such as Wegovy, Ozempic and Mounjaro have skyrocketed in popularity and use. Of the three, only Wegovy is approved as a weight loss treatment — the other two are Type 2 diabetes drugs — but all three have seen high demand for months as weight loss drugs.
With the heightened demand and resulting supply issues, drug manufacturers and shareholders are pushing for Medicare to cover these medications, according to KFF. In the 117th Congress, lawmakers filed a bill aiming to overturn the 2003 law, but the bill did not come to fruition and there is not a similar effort in the Congress' current session.
If new efforts to have Medicare cover these drugs are successful, however, access and equity concerns could diminish, KFF said. Some of these GLP-1 drugs cost about $1,000 for a month's supply, and Wegovy costs 20 times more than older weight loss drugs. With Medicare coverage, financial barriers may dissolve.
Medicare covers obesity screening, behavioral counseling and bariatric surgery, and if Wegovy is added to the fold, Medicare spending could increase 10 percent to 20 percent. In a study, researchers found that if 10 percent of Medicare beneficiaries with obesity use Wegovy, Medicare would spend between $13.6 billion and 26.8 billion more — in 2021, Part D drug spending was nearly $100 billion.
The researchers concluded "it would be prudent for Congress and the Centers for Medicare and Medicaid Services to carefully consider the potential trade-offs associated with anti-obesity medication coverage and use for Medicare beneficiaries.