Medicare should pay for obesity drugs

Obesity is a serious disease that has an extensive toll on patients' well-being. Individuals with obesity are more predisposed to other detrimental conditions such as heart disease, stroke and Type 2 diabetes.

Obesity also disproportionately affects specific populations over others. Non-Hispanic Black adults had the highest age-adjusted prevalence of obesity at 49.9%, followed by Hispanic adults at 45.6%, according to the Centers for Disease Control and Prevention. On the other hand, non-Hispanic Asian adults had a prevalence of 16.1%, while non-Hispanic white adults had a prevalence of 41.4%.

Overall, men and women with college degrees are less likely to be diagnosed with obesity. Compared with spending for someone of normal weight, medical expenditures for someone diagnosed with obesity were $1,429 higher per year.

A combination of individual and societal factors play an important role in developing obesity. These factors may include access to healthy nutrition; safe, convenient and affordable places for exercise; personal stressors and medication use. Medicare helps address obesity through some treatment options for patients. However, some gaps make it difficult for certain patient populations to attain optimal care.

Medicare currently covers bariatric surgery in cases of severe obesity with a BMI higher than 35. In addition, Medicare also launched an Intensive Behavioral Therapy for Obesity initiative in which patients with a BMI higher than 30 can receive free obesity screenings and behavioral counseling to promote long-term weight loss changes. Some Medicare Part C programs may also include gym memberships and subscriptions to healthy home meal delivery programs.

Despite these benefits, one area of coverage not provided by Medicare includes anti-obesity pharmacotherapy. The FDA has five approved drugs for long-term use to treat obesity, including orlistat (Xenical, Alli), phentermine-topiramate (Qsymia), naltrexone-bupropion (Contrave), liraglutide (Saxenda) and semaglutide (Wegovy).

One study has conducted an analysis to project a $20 billion to $23 billion budgetary savings for Medicare over 10 years upon coverage expansion of pharmacotherapy and intensive behavior therapy. Non-coverage of anti-obesity medications may limit treatment choices for beneficiaries and exacerbate outcomes for low-income patients who cannot afford to seek complementary therapies such as anti-obesity medications without insurance.

The reluctance of Medicare to approve anti-obesity medications includes safety concerns with weight-loss medications in the past. Drugs like fenfluramine were found to damage heart valves in 1997. A lack of long-term safety data is another reason the U.S. Preventive Services Task Force does not recommend prescription drugs for weight loss.

Nevertheless, studies have been done that predict the benefit of anti-obesity medication expansion on an individual level. For example, one retrospective study analyzed a representative sample of 2,735 adults from the 2008 to 2016 National Health and Examination Surveys. It ran a 10-year simulation to predict an individual's health status progression based on their individual profiles.

The model discovered that anti-obesity medications, when combined with lifestyle interventions, may help patients lose 9.7% of excessive weight and lead to lower costs in the ER, ambulatory care and inpatient stays, resulting in a net savings of approximately $7,000 over 10 years per person.

Considering anti-obesity medication's potential for significant assistance with weight loss reduction, it is worth deliberating Medicare's expansion for this group of prescriptions to reduce health care costs, improve patients' well-being and reduce the burden of obesity-related chronic conditions.

Not only will Medicare coverage of anti-obesity medications allow individuals to live healthier lifestyles and promote well-being, it will also reduce excessive costs in our already over-inflated health care system.

Jay Talati, Caleb Rowan, Shay Bidani, Matthew Malak, Anastasia Tishena, Alexandria Iakovidis and Ashrita Budharaju are medical students at the University of Florida College of Medicine.