Older Americans support insurance coverage for obesity medications

A large majority of older Americans feel that health insurance – including Medicare – should cover anti-obesity medications, according to a new University of Michigan study.

And more than half of older adults who meet criteria for obesity say they're interested in trying one of these drugs to manage their weight.

Current law prevents Medicare from covering medications to treat obesity, and most private plans don't cover the most effective newer weight management drugs because of cost.

But 83% of older adults surveyed for the study agreed strongly or somewhat that health insurance should cover weight management medications.

Asked specifically about Medicare, 75% of respondents said the insurance program for older and disabled Americans should cover obesity medications. However, the percentage was much lower (30%) when respondents were asked if they'd favor having Medicare cover the drugs even if it meant paying a higher premium for their own coverage.

Timely findings for health policy

The findings, published in JAMA Network Open, have especially timely significance for health policy.

As our nation contends with the impacts of the obesity epidemic on older Americans, and the costs of both obesity-related conditions and the medications that can treat obesity, data like these can inform the discussion over coverage and access."

Lauren Oshman, M.D., M.P.H., lead author of the study and associate professor of family medicine, U-M Medical School

Dr. Lauren Oshman is board-certified in obesity medicine.

A federal rule may take effect this spring that would allow Medicare to cover medications specifically for weight management for the first time, in light of growing understanding of the nature of obesity as a chronic disease. Medicare currently covers a drug that is also used for weight management but only in people with diabetes or a history of heart attack or stroke.

Also this spring, a loophole will likely close that in the past two years gave Americans access to buy compounded versions of two weight management medications while the name-brand medications were in short supply. This loophole led to a surge in individual cash-based purchasing, often via telehealth, because of the lack of insurance coverage and the higher cost of name-brand drugs.

Later this year, Medicare will begin negotiations with the company that makes semaglutide, as part its new price negotiation process. The negotiated price would take effect in 2027.

The study and its context

Oshman and her colleagues analyzed data from the National Poll on Healthy Aging, based at the U-M Institute for Healthcare Policy and Innovation and funded by Michigan Medicine, the U-M academic medical center, and AARP. Some of the data in the paper were previously published as a report.

The new analysis dives deeper into the data from the poll, which was conducted online and by phone in summer 2023 and had 2,657 respondents between the ages of 50 and 80. The results are weighted to be nationally representative.

The poll asked respondents about their knowledge of, and experience with, a range of weight management medications including bupropion-naltrexone, phentermine-topiramate and the incretin mimetics, also called GLP-1 medications. It asked about the drugs by both brand and generic names.

The poll also asked for respondents' height and weight so the researchers could calculate their body mass index, a measure often used as a marker of overweight and obesity. A BMI of 25 to just under 30 is viewed as overweight, and a BMI over 30 is the cutoff for obesity. In all, nearly 37% of poll respondents met criteria for overweight and 36% met criteria for obesity.

Eligibility for weight management medications among insurance plans that do cover them is often based on a BMI over 27, but also usually requires a person to have a condition such as high blood pressure, high cholesterol and/or high blood sugar at the level known as prediabetes.

But such coverage is far from common, largely because of cost of the incretin mimetic drugs. About a third of private insurance plans offered by employers or on the individual market cover these drugs under some conditions, Oshman said, and 13 states now cover them for some lower-income people enrolled in Medicaid.

Interest in taking weight management medication

In all, 35% of all poll respondents said they're somewhat or very interested in using a weight management medication. This figure includes 29% of those with a BMI between 27 and 29.9, and 59% of those with a BMI of 30 or over.

Those who had taken a weight management medication in the past were much more likely to say they are interested in using such a medication again.

However, only a minority of respondents with BMIs over 27 had taken a weight management medication in the past.

Ten percent had used an older drug called phentermine, which is approved for short-term use. About 7% had used Ozempic, the form of semaglutide approved for use in diabetes that also improves weight loss. Just over 1% had used Wegovy, the form of semaglutide approved for obesity, and about the same percentage had used Saxenda (liraglutide), phentermine-topiramate (Qsymia) or buproprion-naltrexone (Contrave). The poll was done before tirzepatide was approved for weight management under the name Zepbound, so the poll did not ask about that medication.

Those who had used a weight management medication in the past were far more likely to agree that insurance plans should cover such drugs.

The poll also revealed a gap by age: 38% of those in their 50s and early 60s were potentially interested in obesity medication, compared with 31% of those age 65 and older.

Those with high blood pressure, diabetes or high blood sugar, lung disease, heart disease or a history of stroke with all more likely to express interest in weight management medications than those without these conditions

Attitudes toward obesity's origins and views of medication

The poll also asked respondents how much they agreed with two statements about obesity, and looked at their attitudes toward weight management medication use and coverage based on how they replied.

In all, 90% of respondents agreed strongly or somewhat with the statement "Obesity is a chronic condition resulting from a combination of genetics, the food environment, medical conditions, and social factors."

Meanwhile, 64% agreed strongly or somewhat with the statement "Obesity is a lifestyle choice resulting from a person's eating and exercise habits."

Current medical science has provided strong evidence for the first statement, showing that obesity is far more complex than calories consumed and burned, Oshman noted. But the poll shows that many people hold both views at once.

People who agree that obesity is a chronic condition were much more likely than others to agree that insurance should cover weight management medications. They were also twice as likely to express interest in taking such a medication.

And nearly all of those who disagreed with the statement that obesity is a lifestyle choice said weight management medication should be covered by insurance, compared with 77% of those who agreed with this statement.

In addition to Oshman, the study's authors are Dina Hafez Griauzde, M.D., M.Sc., an assistant professor in the U-M Department of Internal Medicine who is also board-certified in obesity medicine, and members of the NPHA team Matthias Kirch, M.S., Erica Solway, Ph.D., MSW, MPH, Dianne Singer, MPH, Preeti Malani, M.D., MSJ, J. Scott Roberts, Ph.D. and Jeffrey Kullgren, M.D., M.P.H., M.S., the poll's director. Oshman, Griauzde, Malani, Roberts and Kullgren are members of IHPI, and Kirch, Solway and Singer are IHPI staff.