The agency that oversees Medicare Part D prescription drug plans says it wants the plans to treat obesity as a disease, not as a cosmetic problem.
Today, Medicare drug plans cover anti-obesity medications only when patients need to lose weight to fight diabetes, heart disease or other weight-related conditions.
Instead, the plans should handle use of anti-obesity medications by patients who are already obese the same way they handle drugs for other chronic conditions, officials at the Centers for Medicare and Medicaid Services say in a new set of proposed requirements for the private plans that health insurers will offer Medicare enrollees in 2026.
When Medicare drug plan managers are developing their "formularies," or lists of covered drugs, they should consider GLP-1 agonist drugs and other anti-obesity medications using the same criteria they would use to evaluate the safety and effectiveness of other drugs in the formularies, CMS officials write.
What it means: The plan proposal could create an addition to Medicare benefits for clients with Medicare coverage who are now paying $1,000 or more per month for hot drugs like Wegovy and Saxenda.
Researchers have suggested that GLP-1 agonists and related drugs could also help treat conditions such as cancer, heart disease, Alzheimer's and even Parkinson's disease, both by reducing people's weight and by reducing inflammation.
If those researchers' arguments are correct, widespread use of the new generation of anti-obesity medications could increase many clients' life expectancy and increase the need for them to prepare to possibly live past age 95.
