For millions of people living with obesity, the class of weight-loss drugs known as GLP-1 agonists has been a game-changer (think Wegovy and Zepbound). Studies show that people taking these medications can lose more weight than with lifestyle changes alone.
But for one group of Americans (people on Medicare) at least some of these drugs have been banned because Medicare cannot cover prescription drugs for the sole purpose of weight loss. With wide evidence that obesity itself increases numerous health risks and new indications Although these medications reduce the risk of heart disease and stroke, those limits may be changing.
A bipartisan bill, the Treat and Reduce Obesity Act (TROA)Passing it through Congress would allow Medicare to cover weight-loss drugs for the first time.
Experts say it’s about time.
“Passage of the Treat and Reduce Obesity Act (TROA) is crucial to protecting women’s access to obesity care as they transition to Medicare,” she said. Fatima Cody Stanford, MD, MPH, MPA., associate professor of medicine and pediatrics at Harvard Medical School and physician-scientist in obesity medicine at the Massachusetts General Hospital Weight Center.
Stanford explains that TROA improves comprehensive coverage while improving equitable access to care.
“The TROA aims to expand Medicare coverage to include a broader range of obesity treatments, including FDA-approved medications and intensive behavioral therapy. “This ensures that women can continue their established treatment regimens without interruption,” she said. “The TROA addresses disparities in access to health care, ensuring that all women, regardless of their financial situation, can receive the treatments necessary to effectively manage their obesity.”
The costs of obesity
For 31 million women over age 65 (and another 4 million younger women who qualify for Medicare due to long-term disabilities), lack of Medicare obesity care coverage creates risks. Approximately 10,000 Americans turn 65 every day. more than half of whom are women. With obesity rates reaching 43% For people over 60, losing access to obesity treatments can be especially harmful.
“When women transition from private insurance to Medicare at age 65, they often face a significant loss of coverage for obesity treatments,” Stanford said. “When women who have been receiving ongoing treatment for obesity, including medications, behavioral therapy, and nutritional counseling, experience an abrupt interruption in their care, this can lead to weight regain and worsening of obesity-related conditions.” .
Experts recognize obesity as a chronic medical condition. According to the Centers for Disease Control and Prevention2 in 5 American adults live with obesity. Nearly 6 in 10 of them also have high blood pressure, which increases their risk of heart disease. Nearly 1 in 4 also have diabetes. It is also known that obesity increase risks of certain cancers, pregnancy and fertility problems, and mental health problems, among other conditions.
“Obesity is a chronic disease that requires ongoing treatment,” he said. Alicia Shelly, MDobesity specialist doctor. “Without Medicare coverage for obesity treatment, women are at greater risk for serious health problems such as heart disease, diabetes and cancer. “Long-term support is essential to help prevent these life-threatening conditions.”
Obesity is also a serious economic problem. People with obesity have almost $2,000 more in annual medical costs than people without obesity. Overall, those costs add up to nearly $173 billion in additional medical costs each year in the U.S.
And those are just the direct medical costs associated with obesity. Added to that is the loss of productivity that occurs when employees miss work, are less productive at work due to complications of obesity, or die prematurely or leave the workforce due to a disability. He Centers for Disease Control and Prevention It estimates that obesity-related worklessness alone costs between $3.38 and $6.38 billion each year.
The TROA is one way to reduce these costs.
“By providing coverage for obesity treatments, the TROA supports preventive health measures, reducing the incidence of obesity-related diseases and lowering long-term health care costs,” Stanford said.
In women’s own voices
In a HealthyWomen survey of 1,000 women ages 35 to 64, nearly a quarter reported being diagnosed with obesity and 79% said they were trying to lose weight or reduce their BMI. Another 8% of respondents said they care for someone living with obesity.
Nearly two-thirds of women living with obesity reported they were dieting or considering dieting, and one in five said they were taking or considering taking an anti-obesity medication (AOM).
Survey results show that 8 in 10 women who see a nutritionist said their insurance covers all or part of those costs, but only 6 in 10 said the same about insurance coverage for AOMs.
Women living with obesity said achieving their desired weight would have the greatest positive impact on their physical and mental health, self-confidence and daily activities. But 11% of respondents who reported that they will turn 65 in the next six months (or are caring for someone who will) will not have access to OMA under current rules. Seven percent of women said they have a plan that will no longer cover their AOM next year or are caring for someone in that situation.
The survey also revealed racial and ethnic health disparities. Nearly a third of respondents said they had been diagnosed with obesity or would become obese if they saw a health care provider (HCP) who evaluated their weight. And Black respondents were twice as likely as Hispanic/Latino respondents to categorize themselves this way.
The insurance situation also showed important differences. People with Medicaid, the public insurance program for lower-income Americans, were more likely to say they had been diagnosed with obesity (31%) compared to 20% of those with employment insurance and 17% with other private coverage. . Among respondents with Medicare coverage, 13% said they care for someone with obesity and 26% live with obesity.
Fighting for coverage
“The sudden lack of support and resources can have a detrimental effect on mental health, leading to feelings of helplessness, frustration and depression,” Stanford said. “This may further exacerbate the challenges associated with obesity management.”
Stanford recommends that women transitioning to Medicare be proactive about their care, such as reviewing various Medicare plan options to find the most comprehensive obesity coverage available and/or adding supplemental coverage (known as Medigap). She also recommends consulting healthcare professionals to plan the transition in advance and get their help navigating coverage or finding alternative treatments.
“I recommend developing a plan that outlines available and affordable obesity treatments,” Shelly said. “Currently, Medicare does not cover weight loss medications, so it is important to prioritize optimizing your nutrition and physical activity to support weight maintenance.”
More generally, anyone who is or may someday be covered by Medicare can use their voice to advocate for coverage. Write letters to elected officials, call or visit their offices, or even request meetings to express your support for TROA.
“Stay informed about legislative changes like the Treat and Reduce Obesity Act and advocate for their passage,” Stanford said. “Getting involved with patient advocacy groups can amplify your voice and help drive policy changes.”
This educational resource was created with the support of NovoNordisk, a member of HealthyWomen’s Corporate Advisory Board.
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