Seniors who want access to Ozempic have been priced out, but that could change soon | Opinion

Congress is finally taking action to bring real change to healthcare. We are on the way to helping Americans lose weight.

Everyone knows Americans are overweight. More than 60% of U.S. adults are overweight, and 40% are classified as obese. We are unique in the world with those kinds of statistics. It is so bad, and getting worse, that the AMA has declared obesity a disease.

Those numbers could soon change. The Treat and Reduce Obesity Act (TROA) has left the House Ways and Means Committee where an historic first vote was taken. Many have waited years for this.

Twenty years ago, Congress was committed to helping seniors lose weight. They included Phen-Fen on the Medicare Part D listing of approved drugs. And, it was a disaster. It turned out that Phen-Fen had heart-compromising side effects. Before the lawsuits were settled Congress reacted by pulling any mention of weight loss drugs from consideration.

Today, tested and approved semaglutide drugs from various manufacturers are safe, effective and in high demand. But, they are not listed in Medicare.

The important thing is these drugs are life-extenders and money savers. They help people lose weight and avoid expensive treatments, paid for by taxpayers.

These medications are needed and should be re-listed. With obesity comes higher rates of heart disease, diabetes, strokes, and greater susceptibility to a broad array of diseases. By not addressing weight loss, Medicare seems content to spend billions in hospital and hospice care that could have been avoided. Instead, we need to reduce the need for expensive care in the first place.

Now in the House Commerce and Labor Committee, as soon as funding is announced TROA will move to the floor and be voted to the Senate for their consideration.

When signed into law, seniors who have had weight loss drugs prescribed prior to their Medicare enrollment will qualify to have costs covered. Is that all who should be covered? No. It is just a start.

The demand is so great that a doctor’s prescription is necessary to obtain these drugs even outside of Medicare. A person must be “heavy enough” and have a comorbidity like high blood pressure or heart disease to qualify.

These medications are a godsend for many type 2 diabetics who lose the weight and lose the disease. Weight loss corrects other dangerous conditions as well.

Because the demand is so high, and the supply limited, distribution is highly regulated, and the cost is high. One month’s supply of the weekly injectables is around $1,000.

Drugs like Wegovy and Zepbound have been approved by the FDA and marketed for several years. But, the availability and cost has made them hard to get. Novo Nordisk, maker of Ozempic and Wegovy, has a $4 billion plant under construction in North Carolina. It will employ over 1,000 people. Production will increase. Competition will increase. Prices will drop.

In the meantime $92.2 billion is spent yearly through Medicare on weight-related disease, according to the Missouri Pharmacy Association. Outside of the government system another $200 billion is spent on medical complications related to obesity.

If we restore weight loss medications to Medicare Part D, it is estimated we would save $245 billion over the next decade.

Our gyms are full. Diet programs and counseling are ubiquitous. Healthy food is abundant in our stores. But Americans need help. We need to get a handle on this.

Congress must reinstate weight loss medications for Medicare coverage. What was so easily removed from the listing has proven very difficult to restore. In the meantime, taxpaying seniors suffer and expenses continue to rise, unabated.

Many of these decisions are made by actuaries in the back room. Simply put, pay-in systems like pensions and Medicare, are better off financially when seniors pass. Congress needs a sense of morality to help seniors live healthier and longer lives. Seniors worked a lifetime, still pay taxes and ask very little. Congress needs to pass the Treat and Reduce Obesity Act.