Ozempic is one of several new weight-loss drugs that drug companies and campaigners are urging Medicare to cover.
The drugmakers will profit if Medicare patients can buy the new drugs. Lawmakers who want to resubmit legislation to allow Medicare to subsidize weight-loss drugs are seeking ways to lower taxpayer costs.
Medication for Weight-Loss: Does Medicare Pay for It?
Part A (hospital insurance) and Part B (medical insurance), which make up Original Medicare, do not cover prescription drugs for Medicare participants unless they are given during an inpatient or outpatient hospital stay.
None of the weight loss drugs currently on the market meet these criteria.
Prescription drug plans (PDPs) under Medicare Part D often do not include coverage for drugs used for weight loss. Coverage details and drug formularies are subject to annual modification because these PDPs are provided by private insurers under contract with Medicare.
Part A and Part B coverage is included in Medicare Advantage plans, and in some cases, coverage for weight reduction treatments is expanded to a greater extent.
Read more: Medicare Advantage Is Not Helpful For Many Older Persons Who Have Cancer
Pharmaceutical Firms and Patient Activists both Seek Insurance
If 10% of Medicare recipients took semaglutide (also known as Wegovy and Ozempic), the government would spend $28.6 billion, according to an article published in the New England Journal of Medicine in March.
Medicare has not funded weight-loss drugs since 2003 when a law grouped them alongside therapies for hair loss, fertility, and erectile dysfunction.
After their approval and popularity, GLP-1 agonist weight loss drug manufacturers and supporters want this to change.
In 2022, semaglutide maker Novo Nordisk spent $4.6 million on lobbying. In January, Stat News reported that additional pharmaceutical companies, including Pfizer and Eli Lilly (producer of tirzepatide and Mounjaro, respectively), supported Medicare coverage of obesity drugs.
The NAACP, Moffitt Cancer Center in Florida, and pharmaceutical lobbying groups support coverage. They believe obesity is a disease, not a choice.
Read more: If Medicare Doesn’t Cover Your Prescriptions, What Are Your Options?