Aiming to tackle the high risk of heart problems among older Americans with obesity, Medicare is contemplating an expansion of coverage for a weight-loss medication known as semaglutide
This follows a recent study led by Dr. Alexander Chaitoff and his team from the VA Ann Arbor Healthcare System and University of Michigan Medical School, published in the Annals of Internal Medicine.
Weight loss treatments and weight-loss medication
The study looks into the potential eligibility criteria for Medicare coverage of semaglutide, particularly focusing on individuals with obesity who face elevated cardiovascular risks.
Medicare plans vary widely in their approach to determining who qualifies for coverage, primarily revolving around existing cardiovascular conditions like heart attacks, strokes, coronary artery disease, or angina.
According to the study’s findings, up to 3.6 million individuals could qualify if plans limit coverage to those with a documented history of cardiovascular events. Additionally, another 7 million Americans already meet the criteria due to co-existing diabetes and obesity.
However, the study also highlights a significant number of older adults with obesity who don’t yet have diabetes or a major cardiovascular diagnosis but face heightened future risks. If Medicare adopts a preventive approach by including individuals with high cardiovascular risk scores, assessed using tools like the ASCVD, another 5.1 million and 6.5 million could potentially qualify, respectively.
Reducing cardiovascular risk through weight-loss medication
Dr. Chaitoff emphasised that effective cardiovascular risk management often involves a combination of medications to control blood pressure, cholesterol, and other factors, alongside lifestyle changes such as improved diet and increased physical activity.
Weight loss, he noted, is crucial given its established link to reducing cardiovascular risks.
The debate within Medicare circles now lies on defining “established cardiovascular disease” for eligibility, especially concerning preventive measures versus reactionary treatments based on past diagnoses. Dr. Chaitoff argues for a broader inclusion of preventive strategies, aligning with clinical guidelines recommending weight loss for all individuals with elevated cardiovascular risk.
Negotiations between Medicare and drug manufacturers will determine the cost implications, with estimates suggesting potential expenditures exceeding $10 billion annually if more comprehensive coverage criteria are adopted and a significant portion of eligible individuals opt for semaglutide.
