Medicare Part D, the prescription drug coverage program, is expanding its coverage to include the weight-loss medication Wegovy for patients at risk of heart attacks or strokes. Wegovy is part of the GLP-1 drug group, which also includes Ozempic and Mounjaro, initially developed for managing blood sugar in type 2 diabetes patients but now commonly used for weight loss. While Wegovy and a variation of Mounjaro called Zepbound are approved by the FDA, Ozempic and the original Mounjaro are not.
Currently, Medicare beneficiaries can access drugs like Ozempic for diabetes treatment, but Medicare Part D does not cover GLP-1s for weight loss purposes, as highlighted by John Cawley, an economics and public policy professor at Cornell University. This coverage gap means many Medicare recipients struggling with obesity are unable to access these weight-loss medications.
The ban on weight-loss drug coverage under Medicare Part D, rooted in the Medicare Modernization Act of 2003, is more stringent than the 1990 Medicaid rules that allowed states to opt out of covering weight-loss, fertility, and cosmetic drugs. Cawley emphasized the historical ineffectiveness and dangers of some weight-loss drugs, excluding GLP-1s, which led to these restrictions.
Efforts have been made through the Treat and Reduce Obesity Act to amend Medicare Part D to cover GLP-1s for obesity treatment, but the legislation has not been enacted. Cost is a significant barrier, with monthly list prices exceeding $1,000. While Medicare receives rebates to reduce costs, drugs like GLP-1s remain expensive. The Kaiser Family Foundation reported a substantial increase in Medicare spending on diabetes drugs, including Ozempic, from $57 million in 2018 to $5.7 billion in 2022.
