Older Adults' Views on Insurance Coverage for Weight Management Medications.

Abstract

Importance: Medicare and many commercial insurers do not cover US Food and Drug Administration-approved weight management medications, such as incretin mimetics (semaglutide, tirzepatide, and liraglutide), bupropion-naltrexone, and phentermine-topiramate).

Objectives: To assess older adults' interest in weight management medications and associated characteristics and to understand their perceptions about insurance coverage of weight management medications.

Design, setting, and participants: This survey study used cross-sectional data from a nationally representative sample of US adults ages 50 to 80 years from the July 2023 National Poll on Healthy Aging. Data were analyzed from August to November 2023.

Main outcomes and measures: Outcomes of interest were estimates of interest in taking weight management medication and perceptions about coverage for US Food and Drug Administration-approved weight management medications by insurers, including Medicare.

Results: Among 2657 respondents, 60.3% (95% CI, 56.7%-63.8%) were ages 50 to 64 years, 52.2% (95% CI, 49.8%-54.5%) were female, and 10.6% (95% CI, 9.3%-12.0%) were non-Hispanic Black, 11.4% (95% CI, 10.4%-12.6%) were Hispanic, and 70.3% (95% CI, 68.2%-72.4%) were non-Hispanic White. Overall, 35.1% (95% CI, 31.9%-38.4%) of participants were interested in using weight management medications, including 59.1% (95% CI, 53.4%-64.5%) of individuals with body mass index (BMI) of 30 or greater. Interest was most robustly associated with having used these medications in the past (adjusted odds ratio, 7.57 [95% CI, 4.41-13.02]) and BMI of 30 or greater (adjusted odds ratio, 5.04 [95% CI, 3.48-7.30]). Most participants (of any BMI) agreed that health insurance should cover weight management medications (2176 of 2625 respondents [83.2%]). When asked whether Medicare should cover such medications, most still favored coverage (2097 of 2616 respondents [75.7%]), but fewer approved of paying more for a Medicare premium to ensure coverage (829 of 2604 respondents [30.2%]).

Conclusions and relevance: In this survey study of older US adults, most participants agreed that Medicare should cover weight management medications and more than half of those with BMI of 30 or greater were interested in using them. These results should inform decisions to include weight management medications in the Medicare and commercial insurance programs, as well as utilization policies to control health care costs.