Staying Fit
In this story
Diabetes drug • Obesity issues • GLP-1 meds • Ozempic • Wegovy • Financial assistance • Keep in mind
Medicare doesn’t cover drugs prescribed for weight loss, but it covers popular weight loss drugs Ozempic and Wegovy when they’re prescribed for other reasons. Medicare didn’t cover Wegovy when it was FDA-approved only for weight loss, but it can now cover the drug because on March 8, the FDA approved its use for adults with cardiovascular disease who are also overweight. Medicare also covers Ozempic, an FDA-approved diabetes drug that has unintentionally become popular for weight loss, when it’s prescribed for diabetes.
Medicare Part D can’t cover these drugs solely for weight loss. The 2003 Medicare Part D law for prescription drug coverage specifically excludes drugs prescribed for weight loss or weight gain as well as drugs used for cosmetic purposes, fertility, hair growth, and treatment of sexual or erectile dysfunction.
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“There was skepticism of weight loss medications that existed at the time, and a sense that obesity was more of a behavioral problem than a medical condition,” says Juliette Cubanski, deputy director of the program on Medicare policy for KFF, formerly the Kaiser Family Foundation. Some of the weight loss drugs from the early 2000s were pulled from the market amid safety concerns.
More than 40 percent of Americans 60 and older are considered obese — defined as having a body mass index (BMI) of 30 or higher based on height and weight — according to the Centers for Disease Control and Prevention (CDC). Obesity increases the risk of heart disease, stroke, type 2 diabetes and other conditions. Doctors have been prescribing a new class of medications called GLP-1 agonists for weight loss because studies have found that losing 5 to 10 percent of your weight can have significant positive effects on your health.
What are GLP-1 medications for weight loss?
Glucagon-like peptide-1 agonist (GLP-1) is a new class of medications created to treat type 2 diabetes by helping the pancreas release the right amount of insulin when blood sugar levels are high. These medications have also been found to help with weight loss because they make you feel fuller faster.
On average, the trendy GLP-1 medications have been helping people lose 12 percent of their total weight.
While some GLP-1 medications have been FDA-approved for weight loss, others have not. Novo Nordisk’s Ozepmic and Wegovy have the same underlying product, semaglutide, but they come in slightly different dosages and are approved for different reasons.
- Ozempic is FDA-approved for treating diabetes but not for weight loss, even though some people use it off-label for that purpose. Its popularity as a weight loss supplement is causing drug shortages, affecting those who need it to help control their diabetes.
- Wegovy had already been approved by the FDA for weight loss for people with a BMI of 30 or higher, or with a BMI of 27 or higher and at least one weight-related health issue, such as high blood pressure or high cholesterol. Then, on March 8, the FDA approved Wegovy for adults with cardiovascular disease who are also overweight.
- Mounjaro (tirzepatide) is an FDA-approved diabetes drug that Eli Lilly is investigating using for weight loss.
“You can get your doctor to write you a prescription for off-label use as a weight loss drug, but that definitely does not mean it will be covered by your plan as a weight loss medication, even if it’s covered for diabetes,” Cubanski says.
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