Older Americans want Medicare to cover weight-loss drugs, but cost is a sticking point

A vast majority of older Americans believe Medicare and private insurers should cover prescription weight-loss medications, according to a new study published in JAMA Network Open. Conducted by researchers at the University of Michigan, the research highlights strong public support for coverage, but also reveals financial hesitations that could complicate policy decisions.

Strong support for insurance coverage

The study, which surveyed 2,657 adults aged 50 to 80, found that 83.2% of respondents believe health insurance should cover weight-loss medications, and 75.7% said Medicare should include them. However, support dropped sharply when respondents were asked whether they’d be willing to pay higher Medicare premiums to secure coverage — only 30.2% said yes.

“As our nation contends with the impacts of the obesity epidemic on older Americans, and the costs of both obesity-related conditions and the medications that can treat obesity, data like these can inform the discussion over coverage and access,” said Lauren Oshman, MD, MPH, lead author of the study and associate professor of family medicine at the University of Michigan Medical School.

Medicare’s current policies and potential changes

Currently, Medicare does not explicitly cover medications prescribed for weight loss. It does, however, cover certain drugs used for related conditions, including diabetes and cardiovascular disease.

A proposed federal rule could change that by recognizing obesity as a chronic disease, potentially allowing Medicare to cover weight-loss drugs for the first time.

Additionally, Medicare will soon begin price negotiations with the manufacturer of semaglutide — the active ingredient in Ozempic and Wegovy — with new pricing expected to take effect in 2027. Meanwhile, the Treat and Reduce Obesity Act — a proposed bill that would require Medicare to cover weight-loss medications — has gained some traction in Congress. If passed, it could significantly expand access, but estimates suggest it would increase federal spending by $35 billion over eight years.

Rising interest in weight-loss medications

Interest in prescription weight-loss drugs is high among older adults, particularly among those classified as obese.

• 35.1% of all respondents said they were interested in using weight-loss medications.
• 59.1% of those with a body mass index (BMI) of 30 or higher expressed interest.
• 28.7% of those with a BMI between 27 and 29.9 said they would consider taking the drugs.

Despite this interest, past usage of weight-loss medications remains relatively low. Among respondents with a BMI of 27 or greater:

• 10% had used phentermine, a short-term weight-loss medication.
• 7% had taken Ozempic (semaglutide) for diabetes but also experienced weight loss.
• Only about 1% had used newer weight-loss drugs like Wegovy (semaglutide), Saxenda (liraglutide) or Contrave (bupropion-naltrexone).

Public perceptions of obesity and insurance coverage

The study also examined how respondents viewed obesity and whether these perceptions influenced their stance on insurance coverage:

• 90% agreed that obesity is a chronic condition caused by a mix of genetics, medical conditions, the food environment, and social factors.
• 64% also agreed with the statement that obesity is a lifestyle choice resulting from diet and exercise habits.
• Those who saw obesity as a chronic disease were significantly more likely to support insurance coverage for weight-loss medications.

What this means

For primary care physicians and practice leaders, these findings suggest that patient interest in weight-loss medications is growing, especially as Medicare and private insurers debate coverage policies. The cost of these drugs — often exceeding $1,000 per month without insurance — remains a major barrier to widespread access.

As interest in these treatments continues to grow, physicians will need to remain informed on coverage updates and weigh the benefits of medication against other weight-loss strategies for their patients.