Medicare begins covering GLP-1s for seniors July 1, experts available for interviews

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Medicare begins covering GLP-1s for seniors July 1, experts available for interviews

'This is the first time the federal government has treated obesity like the chronic disease it is'

• Program should be considered an 'equity intervention' since obesity rates are highest in the communities that are least likely to be able to afford GLP-1s, expert says
• Given positive cardiovascular outcomes of GLP-1s, new program 'could even be considered a heart disease-prevention program that happens to start with weight loss'
• Patient, clinicians should be 'vigilant' about potential GLP-1 side effects

CHICAGO --- Starting tomorrow, July 1, the Centers for Medicare and Medicaid Services (CMS) will allow millions of eligible seniors to access GLP-1 medications for a flat $50 monthly copayment under its temporary pilot program, Medicare GLP-1 Bridge. Northwestern University experts are available to speak to media covering this new initiative.

"Seniors have watched Medicare cover almost everything except the thing that would have prevented half their other diagnoses," said health economist Lindsay Allen, assistant professor of emergency medicine at Northwestern University Feinberg School of Medicine. "This is the first time the federal government has treated obesity like the chronic disease it is instead of a lifestyle problem people should just solve on their own."

"This is an exceptional opportunity for Medicare patients to have access to life-saving medications," said Dr. Micah Eimer, a clinical assistant professor of cardiology at Feinberg. "One concern is that older patients have more adverse effects to medication in general. Specifically, in our research, older patients on blood pressure medications were more likely to experience hypotensive side effects, such as fainting and dizziness, after starting a GLP-1," added Eimer.

Eimer, who also is a Northwestern Medicine cardiologist, prescribes GLP-1s to many patients because "they are shown to reduce the risk of dying from heart disease by up to 20% depending on the population."

Allen on cost effectiveness:

"If even a fraction of these patients avoids a heart attack or stroke because of this program, the medications will pay for themselves many times over, and that doesn't even factor in the improved quality of life patients experience.

"Medicare is the biggest buyer of drugs in the country, and it's about time we started using that size to actually negotiate prices down instead of just absorbing whatever pharmaceutical companies charge. It is worth noting President Biden was the first to do this with the Inflation Reduction Act.

"It's incredibly rare for a single drug class to affect this many chronic conditions. Scientists are using it in trials for practically every disease and finding positive impacts. Given just the cardiovascular outcomes we've seen so far, alone, this could even be considered a heart disease-prevention program that happens to start with weight loss."

Allen on this being an 'equity intervention':

"Obesity rates are highest in the communities that are least likely to be able to afford a drug that costs $1,000 a month. A federal program that brings the price to $50 is one of the more direct equity interventions Medicare has made in a while."

Allen on CMS' creative use of a temporary program

"Medicare legally can't cover weight loss drugs right now, and the pilot is CMS' way of using demonstration authority, which is the same tool Medicaid has used for years to get coverage moving without waiting on Congress. This initiative means they'll hopefully be able to gather a lot of data, which will allow them to later go to Congress to change the law."

Eimer's advice for patients and clinicians

"We should all be vigilant about the development of hypotension, or low blood pressure, which is best done by monitoring blood pressure with a home machine and being aware of symptoms such as lightheadedness, dizziness or fainting. In my practice, we check in with the patients on GLP-1s on a monthly basis to discuss blood pressure numbers and symptoms and then adjust medications as appropriate."