Medicare is set to launch a program next month that will provide weight-loss drugs for $50 a month, potentially increasing demand for medications such as Wegovy and Zepbound. This rollout may create challenges for healthcare providers as they prepare for a surge in patients seeking GLP-1 prescriptions. Clinicians have expressed concerns that the influx of patients may limit the time available for counseling on medication use and side effects.
Currently, Medicare has been prohibited from covering weight-loss drugs, but this new program is part of a deal made by President Trump with Eli Lilly and Novo Nordisk to reduce prices for diabetes and anti-obesity medications. Approximately 14 million Medicare beneficiaries are classified as overweight or obese, and many are expected to seek these medications starting July 1.
Before receiving the drugs, beneficiaries must undergo a verification process known as prior authorization. Some healthcare providers are worried that the existing burden of prior authorizations will be exacerbated by the new program. Medicare officials have stated they are working to streamline this process.
The program is set to run until the end of 2027 and will only cover weight-loss drugs, excluding nutrition and behavioral support programs that often accompany obesity treatment. This limitation may pose challenges for older adults who require careful monitoring. Additionally, beneficiaries may face unexpected costs, as the benefit does not contribute to out-of-pocket caps or deductibles.
Pharmaceutical companies Novo Nordisk and Eli Lilly are preparing to market their products to Medicare patients, highlighting benefits such as reduced cardiovascular risks and convenience. However, some seniors may not qualify for the discounted drugs if they have previously received a GLP-1 prescription for other conditions.