Insurance plans could cover blockbuster weight-loss medications such as Wegovy and Ozempic, but the benefits may not be accessible to everyone
Pamela Torres used to run a seven-minute mile. But when the former track star suffered a severe knee injury in college, she began to rapidly gain weight. She was diagnosed with type 2 diabetes in her 30s and obesity in her early 50s. Torres, now age 68, was prescribed Ozempic, a medication approved to treat type 2 diabetes, in January. She lost nearly 20 percent of her body weight. Her joints didn’t ache as much, and her blood sugar returned to healthy levels. “I bought three new pairs of jeans.
Medicare coverage would put antiobesity drugs within reach of many people, including older adults, who can’t otherwise afford them. It could have a multiplier effect because private insurers often follow Medicare’s lead. Even if insurance providers shift their policies, however, there are lingering concerns about whether and how they will restrict coverage for weight-loss medications—and who might be left behind.
These drugs are also reshaping the way doctors and the public perceive obesity, a condition historically seen as a problem of willpower. “Now we have the option to treat obesity like we treat any other disease—with medication,” says Shauna Levy, medical director of Tulane University’s Bariatric and Weight Loss Center.
Still, related GLP-1 medications have been used to treat diabetes for nearly two decades, which has assuaged some physicians’ fears of large-scale safety issues. “You make a risk-benefit calculation when you prescribe any medication,” Weiss says. “But these are not an entirely new type of drug, and there doesn’t appear to be significant lingering safety concerns with them.”
But these savings may be less likely to persuade insurers, according to David Rind, chief medical officer at the Institute for Clinical and Economic Review, a nonprofit organization that estimates fair prices for the U.S. health system. “Will this create more pressure on insurers to cover these drugs? Maybe,” he says. “But I think the exchange is insurers saying, ‘You’re going to have to pay more for premiums,’ which will turn some people away.
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