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Medicare to begin covering obesity drugs

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Millions of older Americans enrolled in Medicare will gain access to prescription obesity medications beginning July 1 under a new federal demonstration program, marking a significant expansion of coverage for weight-loss treatments that have previously been out of reach for many seniors.

The new Medicare Bridge demonstration program will allow eligible beneficiaries to obtain obesity medications for a monthly copay of $50. The program represents a major policy shift for drugs such as Wegovy, made by Novo Nordisk, and Zepbound, produced by Eli Lilly, which have grown in popularity but remain expensive without insurance coverage.

Despite the expanded benefit, a recent survey found many eligible seniors are unaware of the upcoming change. According to the Obesity Care Advocacy Network, 82% of Americans age 65 and older did not know Medicare would begin covering obesity drugs. Awareness was similarly low among both Republicans and Democrats.

Federal officials say the limited public outreach before the program’s launch is intentional. The Centers for Medicare & Medicaid Services has focused on educating physicians, pharmacists and other health care providers first, with broader public promotion expected after the benefit becomes available. Officials said the approach is intended to avoid unnecessary spending on outreach before the program’s start date while ensuring medical providers are prepared for patient demand.

Unlike traditional Medicare prescription drug coverage, enrollment in the Bridge program is not automatic. Beneficiaries must be enrolled in Medicare Part D, obtain a prescription from a health care provider and receive prior authorization from CMS before coverage begins. Some patients will not qualify, including those already receiving Medicare coverage for the same class of drugs to treat conditions such as Type 2 diabetes, cardiovascular disease risk reduction or sleep apnea.

Health policy experts say one of the program’s biggest challenges will be informing eligible seniors about the new benefit. They also note that a gradual rollout may help physicians, pharmacies and CMS manage the expected demand and resolve administrative issues before participation expands.

Source: CNBC

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