Medicare Part D Coverage of Antiobesity Medications — Challenges and Uncertainty Ahead

his Perspective article outlines the growing demand for new-generation antiobesity medications like semaglutide and tirzepatide, highlighting their clinical promise alongside significant cost and policy challenges. Despite widespread obesity among Medicare beneficiaries, the program is prohibited by law from covering weight-loss drugs under Part D. The authors assess budgetary implications under various uptake scenarios, noting potential costs exceeding Medicare’s annual drug budget. They explore international reimbursement policies, cost-effectiveness evaluations, and medical concerns specific to older adults. The article calls for careful consideration of coverage expansion in light of fiscal and clinical uncertainties.

his Perspective article outlines the growing demand for new-generation antiobesity medications like semaglutide and tirzepatide, highlighting their clinical promise alongside significant cost and policy challenges. Despite widespread obesity among Medicare beneficiaries, the program is prohibited by law from covering weight-loss drugs under Part D. The authors assess budgetary implications under various uptake scenarios, noting potential costs exceeding Medicare’s annual drug budget. They explore international reimbursement policies, cost-effectiveness evaluations, and medical concerns specific to older adults. The article calls for careful consideration of coverage expansion in light of fiscal and clinical uncertainties.