WILL MEDICARE COVER WEIGHT LOSS DRUGS?

Those GLP-1 RA drugs are in the news again, and this time, it’s good news for the pocketbooks of the millions of Americans. Glucagon Like Peptide -1 Receptor Agonists are this century’s version of a miracle drug. Statins gained that reputation in the 20th century after they were found to significantly reduce fatal heart attacks and cardiovascular events. In the 21st century, GLP-1RA’s, originally intended for control of diabetes, were found to enable patients to lose significant amounts of weight. That benefit has become the major reason Americans have gravitated toward these drugs en masse. One in 8 Americans have taken GLP-1’s for diabetes, weight loss, or CV disease prevention. Of those folks, “4 in 10 cited weight loss as the reason to take the meds.”

GLP-1’s obviously work very well because Medicare and private insurance do not cover their cost, which can run as much as $1000 per month out-of-pocket. Plus they are an injectable drug a patient has to take daily or weekly. Most people wouldn’t inject themselves or pay $1000 if they weren’t seeing results. 

The GOOD NEWS is there is a move afoot to lift the restriction on Medicare and Medicaid coverage of GLP-1’s. The rule “would greatly expand Medicare and Medicaid coverage for anti-obesity medications and allow access to about 4 million Medicaid enrollees” and later to Medicare recipients. It follows, then, that commercial/private insurers would also cover these drugs expanding insured availability to millions of patients. This coverage is in no way intended to deflect from the focus on proper eating—healthy foods without ultra-processed preservatives—and exercise.  

Covering GLP-1’s will encourage more patients to lose weight. Weight loss, in turn, will lead to healthier adults whose health care expenditures are expected to decline. In the long run, covering these drugs will reduce heart attacks, strokes, ER visits, and uncontrolled BP and diabetes and save the system millions of health care dollars. A poor analogy states that spending money to change the oil in your car every 3000-5000 miles keeps it running longer in good condition and avoids the problems that can come to the engine. 

This policy, like so many others, is decided by the Centers for Medicare and Medicaid Services (CMS), a mammoth bureaucracy that formulates rules that affect the lives and livelihoods of patients and doctors, alike. In my opinion, covering GLP-1’s is as important a step as could be taken to insure the health and longevity of Americans by eliminating the obesity epidemic. I would hope CMS takes the problem seriously, and provides coverage that could have profound benefits. 

Reference: Doheny K. Paying For GLP-1’s: If Medicare Starts, Will Other Insurers Follow Suit? Medscape Medical News 2025 February 15.