This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing! 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.
Just a minor addendum. Medicare also covers people on SSDI or SSI regardless of age.
And now a quibble. Not with you, but with Medicare and Medicaid.
I have been on NP Thyroid for about 15 years now because I can't tolerate Synthroid.
Medicare says people over 50 shouldn't take NP Thyroid. I just turned 59. Again, I can't tolerate Synthroid.
Medicare refuses to cover my NP Thyroid prescription even though my healthcare provider has tried several times to get them to override the refusal.
Medicaid used to cover my NP Thyroid prescription. However, once I started receiving Medicare, Medicaid refuses to cover this prescription because I now have alternative coverage. Since neither Medicare nor Medicaid will cover NP Thyroid, I now have to pay out of pocket. Forgive me for thinking this is a tad fucked up when I'm on SSDI.
It enrages me that Medicare won't cover a prescription I require to correct a hormonal imbalance (results may vary) but they'll be more than happy to cover a diabetes medication being used for an off-label purpose. I'm a diabetic, by the way, and I wouldn't use these medications to treat my diabetes. Insulin is much safer. I also take Januvia, which I've never had a problem with.
I'm so damn tired of it. The other day while looking for suggestions on a way to rebuild my endurance, I found a beginner walking program "for people with overweight and obesity." I hope I can be forgiven for flipping off my monitor.
I don't think health care providers are ever going to see that their emphasis on weight is actually hurting patients. It's distressing to say the least.
I'm so sorry that you are dealing with this, it's all so frustrating and horrible. Thank you for sharing your story here and for the correction. I've corrected the piece and added a link that explains eligibility and apologize for missing that.
Came here to make the same point about coverage of SSDI recipients, I'm glad you already did. :) I'm 39, on Medicare due to SSDI, and have seen a wave of articles recently about the push to get these drugs to older patients on Medicare. None of those authors acknowledged that pushing Medicare to cover these drugs will also open the market to push them to younger, disabled fat folks. Since I'm one of them, I always notice that and wonder if the omission is due to a lack of awareness, or by choice. This piece of yours is actually focused on older patients, but I wish other writing that's uncritically just boosting the idea of these drugs for Medicare seniors would include the fact that Medicare coverage goes farther than that.
Thank you for bringing this up and educating me. I was focused on older adults because that's the population that the drug companies are claiming are unjustly being denied these drugs but I should have included the ways in which Medicare coverage of these drugs can and will harm younger disabled people. Thank you for taking the time and I'm sorry for omitting this serious issue. I've made a note in the piece for folks to read these comments and thank you again for your labor here.
Medicare does not cover people on SSI unless they are elderly. People on SSI typically qualify for Medicaid, which is a different program. Medicare is Federally funded and run by the Federal government. Medicaid is Federally funded and run by individual states, and what it covers can vary from state to state.
People on SSDI are automagically enrolled in Medicare (starting one year after acceptance into the program).
That document says what I said: Medicare goes with SSDI, not SSI. They are different programs. There are very few others (often children) that might qualify for Medicare before age 65 but they still need to meet the requirements for SSDI qualification.
SSDI is typically for people who have paid enough FICA taxes, which feed the Social Security system, no matter how old they are. If you look at your Social Security statement (you can get it online from ssa.gov) it will show you how much you might get at retirement and how much you would get if you were to qualify for SSDI right now. SSDI payments are based on your work history & FICA taxes paid. Sometimes children and/or spouses of people who have died can qualify for SSDI as well, under Survivor Benefits, if they paid enough FICA taxes.
People on SSI are not automatically qualified for Medicare and are unlikely to qualify until they're over 65. Most (but not all!) people on SSI, not SSDI, because they either did not pay enough Social Security taxes (FICA) or they have been disabled since birth. SSI is almost always for people with few resources, and because of this the payments are fixed (that is, everyone gets the same SSI amount) which is horrifyingly small. This is why many people on SSI are on Medicaid, as well as SNAP and other resources for people with lower incomes. There are some people who qualify for both SSI & SSDI but it's not common.
Oh my gosh, thanks for the list of studies about WL over 60 and mortality. Basically all my experience from, you know, being around old people informs my impression that WL in later years is ominous at best. It's seriously weirded me out in the past when people have pointed out an elder's WL as if it were a good thing. I'm glad to have a reference to prove I'm not crazy, lol.
Additionally, private insurers tend to follow Medicare's lead when it comes to coverage, so getting Medicare coverage would also increase insurance coverage and access.
I don't know if this is an angle you've considered, but I'm seeing an increase in articles touting the other benefits of these drugs. There's been a couple of headlines about them helping with anxiety and depression. I saw one article the other day about benefits to kidney patients. (I don't have the exact details but as I understand it Medicare/Medicaid covers all or most dialysis in the states.) I'm wondering if this is an effort to get these drugs covered not just for weight loss but for all the comorbidities that are attributed to fatness. Medicare may be able to deny coverage for weight loss but if it's for weight loss AND depression/anxiety/kidney issues, etc it becomes harder to justify denying coverage.
I am on Medicare due to disability, and I think of two things when I hear about pushing Medicare to cover these drugs:
1. Pharma is desperately attempting to cash in even MORE on end of life care, because not only will they make a fortune on WL drugs, but they’ll make a fortune on the treatments to counteract the side effects of WL drugs. That’ll make the hospitals and doctors more money too. Their eyes are like cartoon dollar signs.
2. Younger disabled people WILL be harmed by this. Weight loss is used by gatekeepers for life saving or life improving treatments, and if Medicare covers WL drugs, it’ll be easier to put that gate up. Drug reps will likely use this as leverage to encourage prescribers to write more scripts and hold actual evidence based treatments hostage until we’re on Wegovy for a year? And who is more likely to be disabled? Marginalized people.
Grabowski, D., Ellis, J., 2001. High Body Mass Index Does Not Predict Mortality in Older People: Analysis of the Longitudinal Study of Aging. Monitoring over 7500 people aged 70+ for 96 months to test the hypothesis that increased BMI (top 15%) increased mortality rates in older people. They found instead that after adjusting for demographics, fat people were far less likely to die than thin people, and theorized that [O word] might be protective compared to thinness or "normal" weight.
2010, Corrada, M., Paganii-Hill, A. Being overweight in adults aged 70-75 is associated with a reduction in mortality risk compared with normal BMI. This is from a long-term study called "The 90+ Study" where they are looking at the health of the oldest people.
Thanks for including the info. As an elder, I'm so weary of receiving newsletters and other publications with weight loss recommendations. In particular, those often come from AARP - usually selling a related book or product. Their refusal to consider the impact of doing harm to the population they intend to serve (people ages 50 and over) is so very disappointing.
I’m on Medicare at age 35 because I’m on SSDI for stage 4 colon cancer. I’ve had my Medicare drug plan deny coverage for the antibiotic that I needed to save my life after an abscess, but today I just got a letter saying they approved the Mounjaro my PCP prescribed. I immediately wrote my PCP a message asking about this because I first took the Mounjaro months ago and stopped because my oncologist said the side effects were too risky for someone with my cancer and the colostomy & ileostomy problems I’m already dealing with. My PCP’s nurse apologized and said she was just submitting PAs for all of the expired medications and to disregard. It was baffling to me that 1) a doctor would submit a prior auth for a medication I have never refilled and 2) that Medicare would automatically accept this pre-auth but not the one for an antibiotic that I actually need.
As a 79 year old fat person, who also happens to be on Medicare I am very aware that intentional weight loss may result in my becoming frail because the “weight” I lose will most likely be muscle mass, not fat. On a personal level, I do everything I can to be active and keep, or at least slow down, the loss of muscle mass we all experience as a natural result of aging. That is where I am with the choices I have made in the context of my overall health.
But what about other seniors who may have decided differently, for reasons of health, to sustain or regain mobility, etc?
We may not agree with their decision, but they have the right to make these choices.
Medicare currently covers Bariatric surgery. Making the new weight loss drugs inaccessible through Medicare will not stop attempts at IW/L within this population of fat people. Unless they are wealthy enough to pay for the weight loss drugs out of pocket, their only choice will be surgery.
Hi Ragen,
Just a minor addendum. Medicare also covers people on SSDI or SSI regardless of age.
And now a quibble. Not with you, but with Medicare and Medicaid.
I have been on NP Thyroid for about 15 years now because I can't tolerate Synthroid.
Medicare says people over 50 shouldn't take NP Thyroid. I just turned 59. Again, I can't tolerate Synthroid.
Medicare refuses to cover my NP Thyroid prescription even though my healthcare provider has tried several times to get them to override the refusal.
Medicaid used to cover my NP Thyroid prescription. However, once I started receiving Medicare, Medicaid refuses to cover this prescription because I now have alternative coverage. Since neither Medicare nor Medicaid will cover NP Thyroid, I now have to pay out of pocket. Forgive me for thinking this is a tad fucked up when I'm on SSDI.
It enrages me that Medicare won't cover a prescription I require to correct a hormonal imbalance (results may vary) but they'll be more than happy to cover a diabetes medication being used for an off-label purpose. I'm a diabetic, by the way, and I wouldn't use these medications to treat my diabetes. Insulin is much safer. I also take Januvia, which I've never had a problem with.
I'm so damn tired of it. The other day while looking for suggestions on a way to rebuild my endurance, I found a beginner walking program "for people with overweight and obesity." I hope I can be forgiven for flipping off my monitor.
I don't think health care providers are ever going to see that their emphasis on weight is actually hurting patients. It's distressing to say the least.
I'm so sorry that you are dealing with this, it's all so frustrating and horrible. Thank you for sharing your story here and for the correction. I've corrected the piece and added a link that explains eligibility and apologize for missing that.
Came here to make the same point about coverage of SSDI recipients, I'm glad you already did. :) I'm 39, on Medicare due to SSDI, and have seen a wave of articles recently about the push to get these drugs to older patients on Medicare. None of those authors acknowledged that pushing Medicare to cover these drugs will also open the market to push them to younger, disabled fat folks. Since I'm one of them, I always notice that and wonder if the omission is due to a lack of awareness, or by choice. This piece of yours is actually focused on older patients, but I wish other writing that's uncritically just boosting the idea of these drugs for Medicare seniors would include the fact that Medicare coverage goes farther than that.
Thank you for bringing this up and educating me. I was focused on older adults because that's the population that the drug companies are claiming are unjustly being denied these drugs but I should have included the ways in which Medicare coverage of these drugs can and will harm younger disabled people. Thank you for taking the time and I'm sorry for omitting this serious issue. I've made a note in the piece for folks to read these comments and thank you again for your labor here.
Medicare does not cover people on SSI unless they are elderly. People on SSI typically qualify for Medicaid, which is a different program. Medicare is Federally funded and run by the Federal government. Medicaid is Federally funded and run by individual states, and what it covers can vary from state to state.
People on SSDI are automagically enrolled in Medicare (starting one year after acceptance into the program).
Medicare does cover some people under 65, there's a full explanation here https://www.ssa.gov/pubs/EN-05-10043.pdf
That document says what I said: Medicare goes with SSDI, not SSI. They are different programs. There are very few others (often children) that might qualify for Medicare before age 65 but they still need to meet the requirements for SSDI qualification.
SSDI is typically for people who have paid enough FICA taxes, which feed the Social Security system, no matter how old they are. If you look at your Social Security statement (you can get it online from ssa.gov) it will show you how much you might get at retirement and how much you would get if you were to qualify for SSDI right now. SSDI payments are based on your work history & FICA taxes paid. Sometimes children and/or spouses of people who have died can qualify for SSDI as well, under Survivor Benefits, if they paid enough FICA taxes.
People on SSI are not automatically qualified for Medicare and are unlikely to qualify until they're over 65. Most (but not all!) people on SSI, not SSDI, because they either did not pay enough Social Security taxes (FICA) or they have been disabled since birth. SSI is almost always for people with few resources, and because of this the payments are fixed (that is, everyone gets the same SSI amount) which is horrifyingly small. This is why many people on SSI are on Medicaid, as well as SNAP and other resources for people with lower incomes. There are some people who qualify for both SSI & SSDI but it's not common.
Oh my gosh, thanks for the list of studies about WL over 60 and mortality. Basically all my experience from, you know, being around old people informs my impression that WL in later years is ominous at best. It's seriously weirded me out in the past when people have pointed out an elder's WL as if it were a good thing. I'm glad to have a reference to prove I'm not crazy, lol.
Additionally, private insurers tend to follow Medicare's lead when it comes to coverage, so getting Medicare coverage would also increase insurance coverage and access.
I don't know if this is an angle you've considered, but I'm seeing an increase in articles touting the other benefits of these drugs. There's been a couple of headlines about them helping with anxiety and depression. I saw one article the other day about benefits to kidney patients. (I don't have the exact details but as I understand it Medicare/Medicaid covers all or most dialysis in the states.) I'm wondering if this is an effort to get these drugs covered not just for weight loss but for all the comorbidities that are attributed to fatness. Medicare may be able to deny coverage for weight loss but if it's for weight loss AND depression/anxiety/kidney issues, etc it becomes harder to justify denying coverage.
I am on Medicare due to disability, and I think of two things when I hear about pushing Medicare to cover these drugs:
1. Pharma is desperately attempting to cash in even MORE on end of life care, because not only will they make a fortune on WL drugs, but they’ll make a fortune on the treatments to counteract the side effects of WL drugs. That’ll make the hospitals and doctors more money too. Their eyes are like cartoon dollar signs.
2. Younger disabled people WILL be harmed by this. Weight loss is used by gatekeepers for life saving or life improving treatments, and if Medicare covers WL drugs, it’ll be easier to put that gate up. Drug reps will likely use this as leverage to encourage prescribers to write more scripts and hold actual evidence based treatments hostage until we’re on Wegovy for a year? And who is more likely to be disabled? Marginalized people.
Adding:
Grabowski, D., Ellis, J., 2001. High Body Mass Index Does Not Predict Mortality in Older People: Analysis of the Longitudinal Study of Aging. Monitoring over 7500 people aged 70+ for 96 months to test the hypothesis that increased BMI (top 15%) increased mortality rates in older people. They found instead that after adjusting for demographics, fat people were far less likely to die than thin people, and theorized that [O word] might be protective compared to thinness or "normal" weight.
2010, Corrada, M., Paganii-Hill, A. Being overweight in adults aged 70-75 is associated with a reduction in mortality risk compared with normal BMI. This is from a long-term study called "The 90+ Study" where they are looking at the health of the oldest people.
Thanks for including the info. As an elder, I'm so weary of receiving newsletters and other publications with weight loss recommendations. In particular, those often come from AARP - usually selling a related book or product. Their refusal to consider the impact of doing harm to the population they intend to serve (people ages 50 and over) is so very disappointing.
Is there someone we should write to? Congresspeople? Or....???
I’m on Medicare at age 35 because I’m on SSDI for stage 4 colon cancer. I’ve had my Medicare drug plan deny coverage for the antibiotic that I needed to save my life after an abscess, but today I just got a letter saying they approved the Mounjaro my PCP prescribed. I immediately wrote my PCP a message asking about this because I first took the Mounjaro months ago and stopped because my oncologist said the side effects were too risky for someone with my cancer and the colostomy & ileostomy problems I’m already dealing with. My PCP’s nurse apologized and said she was just submitting PAs for all of the expired medications and to disregard. It was baffling to me that 1) a doctor would submit a prior auth for a medication I have never refilled and 2) that Medicare would automatically accept this pre-auth but not the one for an antibiotic that I actually need.
As a 79 year old fat person, who also happens to be on Medicare I am very aware that intentional weight loss may result in my becoming frail because the “weight” I lose will most likely be muscle mass, not fat. On a personal level, I do everything I can to be active and keep, or at least slow down, the loss of muscle mass we all experience as a natural result of aging. That is where I am with the choices I have made in the context of my overall health.
But what about other seniors who may have decided differently, for reasons of health, to sustain or regain mobility, etc?
We may not agree with their decision, but they have the right to make these choices.
Medicare currently covers Bariatric surgery. Making the new weight loss drugs inaccessible through Medicare will not stop attempts at IW/L within this population of fat people. Unless they are wealthy enough to pay for the weight loss drugs out of pocket, their only choice will be surgery.