While Medicare covers certain services to treat obesity, Medicare is not allowed to cover Ozempic and other drugs for weight loss under the law establishing Medicare Part D prescription drug coverage. Still, the pressure is on to get Medicare to cover them, Rylee Wilson reports for Becker’s.
To treat obesity, Medicare covers obesity screening, behavioral counseling, and bariatric surgery. But, the Medicare Part D prescription drug law prohibits Medicare from covering weight-loss drugs and a range of other drugs, such as drugs that treat erectile dysfunction. That could change for weight-loss drugs, given the efficacy of new weight-loss drugs and the public pressure to cover them.
GLP-1 drugs, such as Ozempic, are more effective for weight loss than the older drugs. Putting aside these drugs, which come with an enormous price tag, Medicare can’t even cover older weight-loss drugs that cost less. Even when they cost less, spending for all these weight-loss drugs are over the long-term. People generally need to take these drugs indefinitely to sustain their weight loss.
One New England Journal of Medicine study found that covering new weight-loss drugs would increase Medicare spending by more than $25 billion a year. In addition, one of the study’s authors said that these drugs are not cost-effective; they are not so much better than the older generation drugs to justify their huge price tags.
Today, people must pay more than $10,000 out of pocket for GLP-1 drugs to treat weight loss. If Medicare decides to cover these drugs for weight loss, it will mean higher Part D premiums for everyone with Medicare. Given the drug price monopoly that US drug manufacturers still have—without negotiated drug prices—there’s no end to drug company price gouging.
Medicare does cover Ozempic and related drugs to treat diabetes.
Note: Medicare Part D drug coverage will have a $2,000 out-of-pocket cap beginning in 2025. For some people, that’s a huge benefit. But, $2,000 is still unaffordable for a large cohort of people with Medicare. And, as Part D premiums rise, more and more people with Medicare will struggle to afford the premiums for their prescription drug coverage.
Here’s more from Just Care:
- Case study: Costco saves one couple hundreds of dollars over Medicare Part D
- 2023: Medicare Part D prescription drug coverage and costs
- Online pharmacies can save you money
- Six tips for keeping your drug costs down if you have Medicare
- Can we fix our broken health care system without reining in costs?
