Should Medicare, Medicaid Cover Anti-Obesity Drugs? Doctors Speak Out

In what may be one of his final major acts in the White House, President Joe Biden has proposed extending Medicare and Medicaid to cover the costs of anti-obesity drugs increasingly used to help people lose weight.

Obesity is a prevalent health concern in the U.S. According to the CDC, around 40 percent of all American adults are obese, as of August 2023.

There is a higher risk of issues such as Type 2 diabetes, heart disease, strokes, cancers, and other potentially fatal health problems for people who are obese, and their quality of life can suffer badly as the condition becomes more severe.

As a result, there are substantial health care costs associated with the prevalence of obesity because it can cause serious conditions that require expensive treatment, leaving family finances stretched, taxpayers footing the bill—or ailments left untreated.

The use of drugs called GLP-1 receptor agonists—traditionally prescribed to treat Type 2 diabetes—for weight loss has seen success because, for many people, they work as an appetite suppressant, and so reduce their calorie intake substantially.

Whilst the evidence shows effectiveness for a majority of people who use these treatments, there are small risks of serious side effects, and not everyone experiences the same level of weight loss or health benefits.

Medicare and Medicaid programs have covered the costs of these drugs, such as Wegovy and Zepbound, when used to treat diabetes, but they currently do not for obesity. Biden’s proposals would change this.

“Medicare coverage would reduce out-of-pocket costs for these prescription drugs by as much as 95 percent for some enrollees,” said a White House fact sheet on the proposal.

“Approximately 4 million adult Medicaid enrollees would also gain new access to these medications. This proposal would allow Americans and their doctors to determine the best path forward so they can lead healthier lives, without worrying about their ability to cover these drugs out-of-pocket, and ultimately reduce health care costs to our nation.”

But obesity is a complex health problem that often requires multiple interventions and lifestyle changes, rather than the silver bullet of a regular injection. Some believe it should be a question of personal responsibility, rather than taxpayer-funded medication.

So, should Medicare and Medicaid expand to cover anti-obesity drugs? Newsweek asked medical doctors working in this area for their views. Here’s what they said.

Robert F. Kushner, MD, Professor, Departments of Medicine and Medical Education, Northwestern University Feinberg School of Medicine

It is about time. Through the advancement of science, we have evolved from “weight loss drugs” to “medications for treatment of obesity”.

The highly effective incretin-based medications not only cause weight loss in people living with obesity but also are effective in treating a long list of costly and debilitating complications that include diabetes, heart disease, congestive heart failure, and pain from knee arthritis among others.

Treatment of obesity makes sense and should save us money in the long run.

Robert Lustig, MD, MSL, Department of Pediatrics, UCSF

The problem with GLP-1 agonists is that they take our eye off the ball. These drugs are not fixing the problem, they are Band-Aiding the problem.

As soon as you stop them, the weight comes roaring back. The problem with obesity and diabetes is the ultraprocessed food supply. These drugs prevent us from solving the food problem.

Scott Kahan, MD, MPH, Director of the National Center for Weight and Wellness, George Washington University School of Medicine

The exclusion of obesity treatments—including medication therapy—from Medicare coverage has long been an unfortunate oversight.

While coverage won’t solve the obesity epidemic, assuring reasonable coverage for appropriate patients is important to improve health and quality of life for many Medicare beneficiaries with obesity.

It is still a longshot for this to become law, but it’s a milestone just to get to this point.

Samuel Klein, MD, William H. Danforth Professor of Medicine and Nutritional Science; Director of the Center for Human Nutrition at the Washington University School of Medicine

The development of GLP-1 based anti-obesity medications has revolutionized the clinical management of people with obesity because of their ability to achieve large weight losses in conjunction with impressive therapeutic effects on the cardiometabolic complications of obesity, including diabetes, heart disease, liver disease, kidney disease and lung dysfunction.

Accordingly, providing greater access to these medications has important public health implications by reducing disease burden and additional benefits by improving physical function and quality-of-life, particularly in the older adult Medicare population.