Weight Loss Revolution: New Access to Blockbuster Drug for Millions More Americans– Who Will Qualify & The Catch

This is a significant shift from Medicare Part D’s previous stance, which prohibited coverage for weight-loss medications alone. However, following the U.S. Food and Drug Administration’s approval of Wegovy to help reduce the risk of serious heart problems for overweight adults, millions more people may be eligible for the medication known to help with weight loss.

It’s important to stress that Medicare is permitted to pay for Wegovy as long as patients use it to minimize the risk of cardiovascular problems rather than weight loss alone.

“This patient population has a higher risk of cardiovascular death, heart attack, and stroke,” Dr. John Sharretts, director of the Division of Diabetes, Lipid Disorders and Obesity in the FDA’s Center for Drug Evaluation and Research, said in a news release.

A CNBC report noted millions of prescriptions were written for “Ozempic, Wegovy and similar diabetes and obesity drugs” and that prescriptions rose “300% between early 2020 and late 2022.”

According to the nonprofit health policy research company KFF, “more than 50 million of the 65 million people covered by Medicare are enrolled in Part D plans.” Thus, the coverage expansion potentially impacts many more people. However, it may come at a cost.

According to the Centers for Medicare and Medicaid Services (CMS), people using Medicare Part D beneficiaries pay an average of $55.50 monthly premiums.

The Associated Press says Wegovy costs more than “$1,300 a month.” Multiple news outlets, including the Associated Press, note that coverage of the pricey weight-loss drug could leave Medicare Part D users with “higher out-of-pocket fees” though no immediate impacts are expected.

Novo Nordisk’s semaglutide has various brand names, including Ozempic, Rybelsu, and Wegovy—the drug works by impacting the glucagon-like peptide-1 (GLP) GLP-1 hormone.

Integral to blood sugar control, GLP-1 is a hormone released by the gut in response to food. It causes the pancreas to release insulin. A rising blood insulin level causes all body tissues to absorb glucose (blood sugar) from the bloodstream, lowering blood glucose levels. GLP-1 also prevents the release of glucagon, a hormone that raises blood sugar levels by stimulating liver cells to release glucose and helps people feel full for longer. These effects can also cause people to lose weight.

UC Davis Health says, “Ozempic works by mimicking a naturally occurring hormone. As those hormone levels rise, the molecules go to your brain, telling it you’re full. It also slows digestion by increasing the time it takes for food to leave the body. This is similar to the effect of bariatric surgery.”

“Weight loss is a common side effect of using Ozempic to treat diabetes. It is designed to be taken long-term.”

Lexicomp, a resource for medical drugs, says the known side effects of Ozempic include:

• inflammation of your pancreas (pancreatitis)
• changes in vision
• low blood sugar, kidney problems
• kidney failure
• serious allergic reactions

The policy change also impacts private health insurers, who may face added pressure to cover the weight-loss drug. NBC News reports, “a handful of Part D providers, including CVS Health and Kaiser Permanente, have already said they would start covering Wegovy for patients with heart disease risk.”

Since 2018, KFF found that the total Medicare Part D gross spending on GLP-1s—Ozempic, Rybelsus, and Mounjaro—has trended upward. The amount spent rose from “$57 million in 2018 to $5.7 billion in 2022.”

KFF says spending on these drugs is expected to increase with the expansion in insurance coverage.

Cancer Risk and Obesity

Bodyweight can be a sensitive subject for many people on any given day. However, among cancer patients whose treatment and diagnosis may influence their weight, the numbers on the scale fuel an already emotional journey.

The Centers for Disease Control and Prevention (CDC) says, “Being overweight or having obesity are linked with a higher risk of getting 13 types of cancer.”

Research published in the journal “Cancers” says that “Obesity also increases the risk of dying from cancer and may influence the treatment choices. About 4–8% of all cancers are attributed to obesity.”

Some of the cancers associated with being overweight or obese include:

• Colon
• Breast
• Ovarian
• Esophagus
• Pancreatic
• Multiple myeloma
• Endometrial
• Liver

WATCH: Living a healthy lifestyle.

According to the National Cancer Institute (NCI), fat tissue “produces excess amounts of estrogen,” which is associated with an increased risk of certain cancers, including breast, ovarian, and endometrial cancer. The NCI says a person who is severely obese is “7 times” more likely to be diagnosed with endometrial cancer.

Obesity is associated with high levels of insulin, which can lead to colon, kidney, prostate, and endometrial cancer.

Obesity can affect cancer survivors in various ways, including the chance of cancer recurrence and overall quality of life.

To learn more about your ideal healthy weight, determine your body mass index (BMI).

Body weight that exceeds what the body mass index deems appropriate for your weight and height can help determine body fat content. Although your BMI can help you learn if you are at a healthy weight, underweight, overweight, or obese, other factors may contribute to your overall health.

The NCI analyzed several studies to observe physical activity’s impact on overall cancer risk. The NCI says that “higher levels of physical activity are linked to lower risk of several types of cancer.”

Regular exercise, a balanced diet, and managing stress are some ways people can practice leading a healthy life. For cancer survivors, a healthier lifestyle alongside getting regular checks for recurrence may improve your quality of life.

Learn more about SurvivorNet's rigorous medical review process.

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