New Medicare coverage fuels surge in interest in weight-loss drugs
By Jenny Peterson
For years, Dr. Michael “Logan” Rawlins, a bariatric physician, prescribed GLP-1 medications for weight loss to only a handful of patients each month.
Then the drugs became mainstream.
Patients began asking about them specifically after seeing ads, hearing success stories from friends and celebrities and encountering a flood of information on social media.
“In the last year or two we’ve seen a huge boom because there’s so much out there on social media about GLP-1s, what they can do and success stories,” said Dr. Rawlins, Director of Bariatric Surgery at HCA Summerville Weight Loss & Surgical Specialists.
Today, about one-third of the patients in Rawlins’ clinic at are taking weight-loss medications. Now, those patients are increasingly seniors covered by Medicare.
Beginning July 1, Medicare launched a temporary bridge program expanding access to certain GLP-1 medications for weight loss for eligible Medicare Part D beneficiaries.
The program can significantly reduce the cost of the medications. For qualifying patients, the GLP-1 medication costs $50 a month, compared with cash prices that Rawlins says can range from about $200 to $450 a month, depending on the medication and dosage.
The program, currently scheduled to run through Dec. 31, has brought a new group of older patients into Dr. Rawlins’ practice.
“We’ve had a number of patients come through in the last two months,” Dr. Rawlins said in August.
But qualifying isn’t as simple as having Medicare.
Who Qualifies?
Patients must have Medicare Part D prescription drug coverage to participate. Part A and Part B alone do not make someone eligible.
Eligibility also depends on body mass index and certain medical conditions. Patients with a BMI above 35 may qualify based on BMI alone. Those with a BMI above 30 must have certain weight-related conditions, such as heart failure, uncontrolled high blood pressure or chronic kidney disease. For people with a BMI above 27, qualifying conditions can include prediabetes, a previous heart attack or stroke, or symptomatic peripheral arterial disease.
“Medicare has always covered GLP-1s for certain conditions, like Type 2 diabetes. More recently, it was approved for obstructive sleep apnea,” Dr. Rawlins said.
But for weight loss, the process of getting the medication approved can be cumbersome from a provider standpoint.
Dr. Rawlins says providers first have to submit the prescription through the traditional Medicare approval process, receive an expected denial because the patient does not meet an existing condition and then submit additional paperwork approval under the bridge program.
“It’s a lot of work on our end to make sure that the patient meets all the criteria,” he said.
Still, the potential savings are significant for older adults who qualify.
“It does drop the cost down significantly and these medications classically have been very expensive,” Dr. Rawlins said.
More Than a Weight-Loss Drug
GLP-1 medications do more than simply reduce hunger. Dr. Rawlins said that the medications affect areas of the brain involved in appetite and the reward response to food. They also affect insulin regulation and slow the movement of food through the digestive system.
That slower digestion can help people feel full longer, but it can also contribute to side effects, including nausea and vomiting, particularly as the dosage increases.
Patients typically begin with a low dose and gradually increase it. Dr. Rawlins sees his patients about every six weeks to monitor their weight, appetite, side effects, diet and exercise and determine whether the medication should be adjusted.
He typically expects patients to remain on the medication for about a year, which is when he says they are likely to lose the most weight.
“For most of my patients, I tell them I expect them to be on it for about 12 months,” Dr. Rawlins said.
Medication or Surgery?
As GLP-1 medications have become more popular, Dr. Rawlins says it is important to understand that they are not necessarily the best choice for every patient.
He estimates that people taking GLP-1 medications typically lose about 10% to 15% of their total body weight, although individual results vary.
For someone who needs to lose 30 or 40 pounds, medication may be an effective option. But for someone with severe obesity who needs to lose 100 or 200 pounds, medication alone may not produce the desired results.
In those cases, bariatric surgery may be more effective. Dr. Rawlins says patients with a BMI above 40 often see greater long-term results from surgery because the procedure changes the body’s anatomy and disease process.
He doesn’t view medication and surgery as competing treatments.
“Why wouldn’t we treat obesity with multiple different treatment methods?” he said.
A patient’s treatment plan might include medication, surgery, lifestyle changes or a combination of approaches. The goal is to determine what works best for the individual.
What Happens When the Medication Stops?
Perhaps one of the most important considerations for anyone starting a GLP-1 is what happens after treatment ends.
The medications suppress appetite while a patient is taking them, but stopping treatment can allow hunger to return, potentially leading to some regain of lost weight.
Dr. Rawlins sometimes uses lower doses for maintenance rather than stopping treatment altogether.
Dose changes and discontinuation should be managed with a medical professional. For older adults, that ongoing supervision is particularly important.
As Medicare’s new coverage makes GLP-1 medications accessible to more seniors, Dr. Rawlins sees them as another tool for treating obesity, a complex chronic disease.
“It’s not about one versus another,” he said. “It’s about finding the right approach.”
For seniors who qualify, a GLP-1 may be one more option for managing weight and improving health.
But Dr. Rawlins says the medication works best as part of a broader plan that includes nutrition, physical activity, medical care and realistic, long-term goals.
