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Medicare Now Covers Some Weight Loss Drugs — but Older Adults Should Weigh the Risks
Some Medicare enrollees can get popular GLP-1 weight loss drugs for $50 a month, but the medications come with special considerations for people 50-plus
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Key takeaways
- Medicare’s new bridge program offers some eligible beneficiaries GLP-1 weight loss drugs for a $50 monthly copay.
- Older adults should review possible medication interactions because GLP-1s can affect how some drugs work and may require your doctor to change the dose of your other medications.
- Other risks older adults should consider are muscle and bone loss, dehydration and digestive side effects.
Popular GLP-1 weight loss drugs are now available to some Medicare enrollees for $50 a month under a new bridge program that launched July 1, marking the first time Medicare has covered any medication for weight loss.
The lower copay, a fraction of what the drugs can cost out of pocket, will no doubt increase accessibility to nearly 4 million beneficiaries who could be eligible for a prescription. But while there are real benefits to GLP-1s, experts caution there are also risks — and the risks can be higher in older people, says Dr. K. Eric De Jonge, director of geriatrics at MedStar Washington Hospital Center in Washington, D.C.
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Very few people 65 and older were enrolled in the clinical trials reviewed by federal regulators for the drug’s approval, says Dr. Alissa Chen, who treats older adults with obesity at Yale New Haven Health. This left doctors with limited evidence about how the drugs affect older adults. What’s more, many older adults have coexisting health issues and take medications to treat them that can be affected by GLP-1s.
Here are five things older adults should discuss with a doctor before starting a GLP-1.
1. Drug interactions
GLP-1 drugs slow stomach emptying, which is part of why they keep you feeling full — and that same slowing can change how quickly some oral medications reach the bloodstream.
“For most drugs, that shift in timing doesn’t matter much. But it can matter for medications with a narrow therapeutic index — ones where the gap between too little and too much is small, and where too little can be as dangerous as too much,” says Dr. G. Caleb Alexander, founding co-director of the Johns Hopkins Center for Drug Safety and Effectiveness.
These drugs include warfarin, thyroid hormone (levothyroxine), digoxin, some anti-seizure medications and transplant anti-rejection drugs. GLP-1 drugs may also affect the amount of blood pressure or diabetes medication you need, since weight loss can improve both conditions. So your doctor may need to adjust your dosage of these drugs if you are taking a GLP-1; you may even be able to get off of them altogether, says Tina Zolfaghari, an ambulatory pharmacist specialist and assistant clinical professor at the University of California, San Francisco.
A study presented at the annual meeting of the Endocrine Society earlier this year, for example, used health records to track more than 42,000 adults taking at least two types of blood pressure medications. After starting GLP-1 drugs, some patients experienced higher rates of dizziness, fainting and other health events linked to low blood pressure. The events were most common among people 65 and older and people with diabetes.
“Patients with diabetes or hypertension should monitor blood sugar and blood pressure more closely early in treatment because medication doses may need to be reduced, says Dr. John Batsis, a geriatrician at the University of North Carolina School of Medicine who studies GLP-1 drugs in older adults.
“If a GLP-1 medication is stopped, those conditions should be reassessed, since weight regain can increase medication requirements,” he says.
2. Muscle and bone loss
Weight loss can decrease both bone and muscle mass, which increases the risk of osteoporosis and fractures — already significant concerns for many older adults, says Dr. Kashif Munir, medical director of the University of Maryland Center for Diabetes and Endocrinology. What’s more, GLP-1s cause people to eat less, so you may be skimping on nutrients that are important for bone health, such as calcium and vitamin D.
Munir says strength-building exercises are important for all older adults and especially older ones taking GLP-1 drugs. He recommends incorporating weight-bearing exercises into your routine and increasing your calcium, vitamin D and protein intake to lower the risk of muscle and bone loss.
Many hospitals and recreation centers offer free strength-training classes, both in person and online. Munir says older adults on GLP-1 drugs might also consider using wrist and ankle weights when they walk.
3. Dehydration
GLP-1s blunt not only hunger cues but thirst cues as well, which can lead to dehydration. This side effect is especially concerning in older adults, who are already more susceptible to dehydration from age-related changes. Dehydration can cause dizziness, weakness and confusion and can increase the risk of falls — the leading cause of injury for adults 65 years and older.
4. Cost
The $50 monthly copay for GLP-1 drugs covered under Medicare’s bridge program — Wegovy pill, Wegovy injection, Zepbound KwikPen and Foundayo pill — is far lower than the drugs’ list prices. Still, cost remains an important consideration.
Don’t forget to factor in any additional costs, such as doctor visits and lab tests that may be necessary. What’s more, it’s important to note that the bridge program operates outside of Medicare Part D plan coverage, meaning the $50 copays will not count toward Part D deductibles or the out-of-pocket spending cap.
5. Gastrointestinal issues
Gastrointestinal issues, like nausea, vomiting and diarrhea, are a common side effect of GLP-1 medications. A recent review of studies, led by Chen, found that older adults are more likely to experience these symptoms when taking these drugs.
Constipation is another common side effect of GLP-1s; it’s also a common issue affecting older adults. As many as one-third of adults 65 and older struggle with constipation.
Digestive side effects can get better as your body adjusts to the medication. Eating smaller meals and avoiding rich or spicy foods can help. If your abdominal pain is severe or you have signs of dehydration, such as dizziness or trouble urinating, call your doctor’s office right away.
Talk to your doctor
The bottom line, experts say, is not to stay away from GLP-1s but to talk to your doctor — including any specialists you see, Chen says — about the risks and benefits and to keep the conversation going.
“Most patients should be seen every four to eight weeks during dose escalation so side effects, weight loss, nutrition and medication adjustments can be monitored,” Batsis says. “Once they are on a stable dose and doing well, visits can usually become less frequent.”
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