You can’t turn on the TV and not hear about one weight loss drug or another. That has led to many people asking the question; what insurance covers Wegovy (GLP-1s)?
As of March 2024, the House Ways and Means Committee voted to pass the Treat and Reduce Obesity Act of 2024. This bill will allow Medicare Part D plans to cover GLP-1s (glucagon-like peptide agonists) to treat obesity when the enrollee is prescribed the drug before enrolling in Medicare. CMS approved Part D coverage of the weight loss drugs when prescribed for individuals with heart disease or strokes. The drugs are not approved for coverage when prescribed for weight loss alone.
Weight loss for prevention
The Ways and Means Committee suggested that covering drugs for weight loss alone makes sense as weight loss can prevent several illnesses triggered by obesity. By preventing obesity, medical treatment costs can be lower in the future.
It is a fact that obesity is a risk factor for several other medical conditions including diabetes, heart disease and even cancer. Many of these diseases are leading causes of mortality.
What is the cost of Obesity
It is estimated that obesity will cost the federal government over $4 trillion in the next 10 years due to rising healthcare costs for overweight Americans.
If this legislation does not pass, millions of people who are enrolling in Medicare lose coverage for potentially life-saving medications. These drugs have given many people back their lives and provided an opportunity for a healthier, active lifestyle.
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What if the legislation does pass
If the legislation passes and becomes a law, the already high demand for these drugs would grow even more. That in turn, could present greater supply issues than already exist. Manufacturers have imposed restrictions on off label use to try and deal with supply issues.
If this is legislation passes, the cost would be about $1.7 billion over the course of 10 years. This is the estimated cost only for drug coverage of those who had the prescription before they enrolled in Medicare. Some members want to be sure people do not lose this coverage just because they retire.
Future considerations
Some consider this bill as a step toward broader coverage. According to the Senate Health, Education, Labor and Pensions Committee, this could cause a significant impact on federal spending of about $400 billion annually if half of obese Americans took the drug.
Some committee members oppose the bill stating that; if even 10% of Medicare enrollees used the drug, it would cost approximately $27 billion each year. Although, other members would like to compel manufacturers to lower the cost of GLP-1s.
There are good arguments on both sides of this issue. We will all have to wait and see what happens next.
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