Medicare is about to launch an experiment of historic scale. Beginning in July, seniors with a diagnosis of obesity will be able to access GLP-1 medications with a $50 co-pay through the Bridge program. The change comes after the Trump Administration ended a longstanding rule prohibiting Medicare, the government program for senior health insurance, from covering weight-loss drugs.
For seniors, the change in policy will dramatically expand access to a revolutionary medication. While 1 in 5 Americans have taken GLP-1s, those 65 and older report using the drugs at relatively low rates, in part due to prohibitive out-of-pocket costs. Broadening coverage for obesity is likely to make a big difference; about 40% of seniors have BMI-defined obesity, and across all demographics, older adults are among the fastest growing cohorts of obesity patients.
The hidden risks for older adults
But there are also significant risks. Not all seniors, even those with a diagnosis of obesity, will necessarily benefit from being prescribed one of these medications. At the same time, any senior who is prescribed and chooses to pursue a GLP-1 regiment for managing their weight loss will need support for managing some of the known side effects of these drugs, which can have a significant impact on quality of life.
I am most concerned about sarcopenia, which is a chronic illness defined by the progressive loss of muscle mass as we age. While some age-related muscle loss is normal, usually around 1-2% per year, sarcopenia involves much more rapid decline. Patients who have taken GLP-1s demonstrate a high degree of muscle decline as part of their overall weight loss, sometimes as much as 40%.
From obesity to frailty?
Our muscles help protect our bones and joints, so a decline in muscle mass can leave us vulnerable to significant injury, especially for seniors who are already experiencing a natural decline. Loss of strength, particularly in the lower body, can result in falls, which themselves are the leading cause of injurious death for people over 65. Falls also happen to cost $80 billion every single year, with most paid by Medicare.
The risks of the Bridge program, then, are stark: we trade one mortality driver, obesity, for another, frailty, with no meaningful difference in overall outcomes or cost of care.
This fate is hardly a foregone conclusion, but it will require the private sector, especially Medicare Advantage payers, hospital systems, and other senior-focused health care organizations, to take steps to ensure that their patients are afforded access not just to medication, but also services that can help them mitigate side effects and maximize the benefits of their GLP-1 prescriptions.
The missing piece: Fall prevention and wraparound care
What are these resources? It has always been striking to me that access to fall-prevention support is so limited within Medicare. The U.S. Preventive Services Task Force (USPSTF) has long recommended strength and balance training for older adults at high risk of falls, usually the prerequisite for no-cost coverage from insurers. But fall prevention is actually the only service recommended by the USPSTF that is not fully covered based on these recommendations.
Put simply, any senior on a GLP-1 medication is at elevated fall risk. Ensuring they have access to the necessary wraparound support, including strength and balance training, nutrition counseling (seniors on GLP-1s require a protein-rich diet to help maintain muscle mass as they lose weight) and stress management is paramount.
For the private sector, the arrival of the Bridge program should be a clarion call for action. Even though the government will absorb the costs of GLP-1 prescriptions through the Bridge program, these organizations are still responsible for the total cost of care of their patients, including any costs from unmanaged side effects. Now is the time to make companion resources accessible to the same degree as GLP-1 drugs themselves.
Making powerful, effective medications for obesity, a disease linked to a host of other debilitating chronic conditions, more accessible is a welcome step forward. Amidst America’s chronic disease crisis, the Bridge program has the potential to improve the lives of millions of people. And while research to date has been inconclusive (at best) as to the impact on cost of care from increased GLP-1 usage, there remains potential for these drugs to also help take a bite out of ballooning health care costs, helping the Medicare program remain solvent and robust for future generations.
Policy has done its part. Now it’s up to the private sector to ensure we reap the benefits.
Photo: THOM LEACH / SCIENCE PHOTO LIBRARY, Getty Images
Dr. Sandeep Palakodeti is Chief Medical Officer of Bold, an AI-enabled healthy aging company. In his role, Dr. Palakodeti is responsible for designing Bold’s care model and driving clinical outcomes at scale across the diverse populations the company supports, including polychronic and dual-eligible members. Dr. Palakodeti brings over two decades of experience at the intersection of value-based care, longevity medicine, and healthcare innovation. Prior to joining Bold, he was the founding chief medical officer of Hopscotch Health, a primary-care company focused on rural populations. Dr. Palakodeti received his Doctor of Medicine and Master of Public Health degrees from Wright State University, completed his Internal Medicine residency at Kaiser Permanente, and did his fellowship in Healthcare Innovation at Harvard Medical School. He has held leadership positions at Mayo Clinic, University Hospitals, and CareMore Health.
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