Seniors in Medicare to Get Obesity Drug Coverage

Millions of older Americans in Medicare are about to gain access to obesity drugs for the first time — but that landmark shift may be flying under the radar for many of them.

Starting Wednesday, eligible beneficiaries can get obesity drugs through Medicare’s new Bridge demonstration program for a monthly copay of just $50. The coverage marks a long-sought victory for patients, physicians and obesity advocates who have pushed for broader access to the blockbuster treatments from Novo Nordisk and Eli Lilly, which have remained out of reach for many Americans.

But a staggering 82% of all older Americans — including 79% of Republicans and 84% of Democrats — say they are unaware that Medicare is about to begin covering obesity drugs, according to a survey released in early June by the Obesity Care Advocacy Network. The survey, conducted in late March among more than 2,100 adults ages 65 and older, was completed weeks before the government announced it would extend the Bridge program through 2027.

That data may not come as a surprise: While the government has done robust outreach to healthcare providers and pharmacists, some physicians and other experts told CNBC that they have noticed limited advertising of the new coverage to the general public from the Centers for Medicare & Medicaid Services or Novo and Lilly.

There may be good reasons for it. CMS has done limited public outreach on the program ahead of July 1 because beneficiaries are “most moved to take action” when a benefit is actually available to them, an agency official told reporters on Thursday. They added that CMS will put out more promotions after the launch, “in the interest of being good stewards of our taxpayer dollars.”

Other experts also told CNBC that it may come down to making sure providers and pharmacies are prepared and resources are in place before pursuing broad public outreach. [...]

Unlike traditional Medicare drug coverage, enrollment in the Bridge program is not automatic. Patients must meet eligibility requirements, obtain a prescription and receive prior authorization approval through CMS before coverage begins.

by Annika Kim Constantino, CNBC | Read more:
Image: Dhiraj Singh|Bloomberg|Getty Images

[ed. Feels like there's more to this story. Why is no one clamoring to get credit (or market share)?]