Regulators Open The Door For Medicare To Cover Weight Loss Drugs

( — On Friday, March 8, the Food and Drug Administration (FDA) approved the use of Wegovy to reduce the risk of heart attacks, strokes, and other cardiovascular problems in adults with heart disease who are also overweight, which some are saying may be a game-changer for people on Medicare getting access to the expensive drug. Wegovy is a popular weight-loss medication of the semaglutide variety that has also been approved for use by diabetics. Semaglutides work by regulating the appetite, which can effectively lower calorie intake.

Currently, weight-loss drugs are not covered by Medicare. Vivian Yu, a dietician, nutritionist and co-founder of Gym Near Me, says that Medicare has not previously approved medications specifically for weight loss because there was not strong evidence that they were effective, and they often came along with possible serious side effects. She added that the new approval from the FDA for Wegovy to be used for heart conditions could change the landscape around the issue. Pharmaceutical lobbyists are also trying to get FDA approval for the drugs to be prescribed for other conditions commonly associated with obesity, such as sleep apnea and kidney disease.

However, getting the medication into the hands of Medicare patients could still be a challenge. Drugs like Wegovy, Ozempic, and other semaglutides are expensive. Over 40% of Medicare recipients have at least one heart condition, which would make more people eligible for prescriptions. While this could mean more patients have access to medications they’ve previously been denied, Medicare may decide to continue to support less expensive drugs like statins to treat heart problems rather than something like Wegovy, which can cost up to $1,300 per month.

The cost is not the only issue with access, though. Wegovy and other weight-loss medications are already experiencing shortages, which could only worsen as more patients are given prescriptions for them. It is important to note that these new weight-loss medications, while also useful for other conditions, are not a magic bullet. Among the list of common side effects like diarrhea, fatigue, or headaches, there are also potentially serious problems like hypoglycemia and thyroid tumors. If Medicaid does decide to cover Wegovy, it will probably not go into effect until next year, as they don’t usually alter member premiums midyear.

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