The Dangers of Medicare Coverage for Wegovy, Zepbound, and other Weight Loss Interventions

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Moving forward I’m going to be writing about efforts on a number of fronts that are trying to recommend weight loss and, in particular, weight loss drugs to older adults. Much of this is part of the weight loss industry’s holy grail of getting their drugs approved by Medicare.

The backstory here is that the law passed in 2003 that created Medicare Part D specifically prohibits Medicare part D plans from covering weight loss medications.

The weight loss industry, led by pharma companies, particularly Novo Nordisk, Eli Lilly, and their astroturf organizations like “Ob*sity Action Coalition” and “The Ob*sity Society”, are currently engaged in a full-court press to get Part D coverage of these diet drugs.

Medicare is government-run insurance predominantly for people 65 and older in the US (a full eligibility explanation can be found here.) EDIT: While I discuss harm to older adults in this piece, I absolutely recommend reading the comments below to learn more about how this can and will harm younger disabled people who are covered by Medicare, with apologies for my omission.

As we discussed previously, a big part of the weight loss industry’s manifest destiny-esque approach to expanding their market is to get their drugs used by ever younger and older markets, and to get government-funded insurance coverage.

Medicare coverage is important to them not just because it expands their market, but because it means that they can continue to set the price for their medications much higher than most people can afford and then pass the additional cost onto taxpayers. For example, Wegovy, Novo Nordisk’s current diet drug  is about $1,300 per month and must be taken for the duration of someone’s life or, Novo’s own research shows, weight will be quickly regained (though I do want to point out that at this point we only have a couple years of research and it suggests that weight may be regained even by those who stay on the drugs.)

Per a KFF report called “What Could New Anti-Ob*sity Drugs Mean for Medicare?”

“If 10% of Medicare beneficiaries with ob*sity use Wegovy, the annual cost to Medicare could be $13.6 billion (based on a 19% ob*sity rate from traditional Medicare diagnoses in 2021) to $26.8 billion (based on a 41.5% ob*sity rate from survey data for adults ages 60 and older). Higher take-up rates would mean higher Medicare spending. For context, total annual Part D spending in 2021 was $98 billion. “

They also point out that:

“If covered by Medicare, weight loss drugs could be among the limited number of drugs that will be subject to Medicare’s new drug price negotiation authority, but not for several years. At the earliest, a negotiated price for semaglutide, for example, would not be available before 2027 (based on FDA approval in late 2017) and not before 2031 for tirzepatide (based on FDA approval in 2022). Another provision would subject weight-loss drugs to the new law’s inflation rebate that aims to limit annual increases in drug price”

And, again, they “could be” among the drugs subject to price negotiation authority but it’s not certain.

I’ll get into the legislation and campaigns in upcoming posts, but I think it’s important to talk about the fact that Medicare coverage of drugs is obviously good for the pharmaceutical companies (and their astroturf orgs) but is it good for the patients 65 and older on Medicare?

The first question to ask is how many people in this age group were actually part of the study population. Study results (both the tested outcomes and side effects,) can only be applied to people in the same demographic groups as those who were in the study. While they don’t include specific numbers in terms of age, we know for example that in Novo’s Step 5 Trial most participants were female (cis-female, with no trans or non-binary representation,) a staggering  93.1% were white, and they had a mean age of 47.3 years. For Eli Lilly’s Zepbound SURMOUNT – 4 trial, 70.6% of randomized participants were cis-women (with no trans or non-binary representation) and 80.1% were white, with an overall mean age of 48 years old. It’s concerning that the average age is almost two decades younger than the youngest Medicare recipients. Given the mean age and standard deviation, it appears that few of the study participants were age 65 and above. and even fewer were also cis men and/or people of color.

When they are out there claiming that the lack of Medicare coverage for these drugs for people over 65 is a deep injustice, maybe ask why they didn’t bother to include this population in the drug trials they funded and conducted at the same rates at which they appear in the population, which means that the use of the drugs among the population is, essentially, experimental medicine. (The same question can be asked about their push to get their drugs to marginalized communities, including BIPOC who were underrepresented in their trials, but that is a topic for a different day.)

There’s also the growing body of evidence that shows muscle loss with these drugs. Given that older adults, including and especially postmenopausal cis-women who experience muscle loss are specifically at higher risk for developing osteoporosis and/or becoming frail, this is significant.  A NYT article called “The Risks of Taking Drugs Like Ozempic When You’re Over 65” explains “The more muscle someone over the age of 65 loses, the greater their risk of becoming frail or suffering a fracture or fall (which can be fatal in older adults). It is crucial for older adults to maintain muscle mass.” It also points out that  these medications can increase the risk of low blood pressure and compromise strength and stamina.

Dr. Andrew Kraftson, a clinical associate professor at Michigan Medicine said in the article “The picture of frailty would be someone with osteoporosis, prone to fall, who has fractures, who’s unable to do a lot of their activities,” These drugs, when given to those 65 and older (aka Medicare eligible) appears to increase the risk of exactly that situation.

In fact, there is already a body of research finding that weight loss, including intentional weight loss, in older adults consistently increases the risk for everything from fractures to earlier death. Before I get into this there are some things to note:

• I don’t link to studies that include weight stigma, but I do give enough information to Google

• This is not an exhaustive list, feel free to add studies I didn’t include in the comments

• I have many issues with the methodology of these studies, and the studies covered more than what I’ve quoted below. My point here is that it is a significant enough body of evidence over a long enough timeline to create serious concern about pushing these drugs on older adults.

Here are some of the studies:

Even a modest (3%) decline in body weight is an independent marker of increased mortality risk in older adults (Newman et al, 2001, Weight change in old age and its association with mortality)

Older [cis] women who experience weight loss in later years have increased rates of hip-bone loss and a two-fold greater risk of subsequent hip fracture, irrespective of current weight or intention to lose weight.
—Ensrud, 2003, Intentional and unintentional weight loss increase bone loss and hip fracture risk in older women

In older adults higher BMI is associated with lower mortality rates
—Janssen et al, 2005, Body mass index is inversely related to mortality in older people after adjustment for waist circumference

Older [cis] men who lost weight, total lean mass or total fat mass had a higher risk of mortality than men who remained stable.
—Lee et al, 2011, Mortality Risk in Older Men Associated with Changes in Weight, Lean Mass and Fat Mass)

Weight loss is associated with higher mortality risk among community-dwelling adults 60 years and older.
—Cheng et al, 2015, Weight Change and All-Cause Mortality in Older Adults: A Meta-Analysis

Weight loss from middle to late adulthood was associated with increased risks of mortality
—Chen et al, 2019 Weight change across adulthood in relation to all cause and cause specific mortality: prospective cohort study.

“We found that weight loss was associated with a higher risk of mortality regardless of change in physical activity…our findings suggest that maintenance of physical activity is beneficial in this group, it does not eliminate the increased mortality associated with weight loss.”
—Nordstoga et al, 2019, Long-term changes in body weight and physical activity in relation to all-cause and cardiovascular mortality: the HUNT study

Among studies examining BMI change, increases in BMI demonstrated lower mortality risks compared with decreases in BMI
—Javed et al, 2020, Body mass index and all-cause mortality in older adults: A scoping review of observational studies

Weight loss of ≥5% vs stable weight was associated with lower odds of longevity
—Shadyab et al, 2023, Association of Later-Life Weight Changes With Survival to Ages 90, 95, and 100: The Women's Health Initiative)

Among men, loss of 5% to 10% of body weight and loss of more than 10% of body weight were associated with a 33% and 289% increase in mortality, respectively; among women, loss of 5% to 10% of body weight and loss of more than 10% of body weight were associated with a 26% and 114% increase in mortality, respectively
—Hussain et al, 2023, Associations of Change in Body Size With All-Cause and Cause-Specific Mortality Among Healthy Older Adults

We know that the pharmaceutical industry in general (and Novo Nordisk in particular in their treatment of insulin,) have a long history of putting profits over people and the push for Medicare coverage of these drugs certainly seems consistent with that previous behavior.

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More research and resources:
https://haeshealthsheets.com/resources/

*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.