As our understanding of obesity as a chronic disease has evolved, one paradox has been the ongoing barriers to accessing effective therapeutics for this condition, an approach vastly different from the way we treat other chronic diseases like heart disease, hypertension, or cerebrovascular disease.
Thankfully, that era has ended, and in July of this year, Medicare will begin covering access to GLP-1s for the treatment of obesity.
Why is this important for women’s health? While the incidence of obesity is similar for men and women, the incidence of severe obesity is higher in women compared to men, and there are additional impacts of obesity throughout the life stages of women, from fertility to pregnancy to menopause.
Menopause, in particular, is an inflection point for women and the point at which there is an increased risk of chronic disease. Being able to fully address obesity and the risk that it imposes on heart disease, stroke, and other conditions can have a significant impact on health for women in this life stage.
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The new Medicare program to cover GLP-1s is intended to be a bridge that will allow access to these novel therapeutics. It’s important to note that the Bridge program will operate separately from the Medicare Part D program, and eligibility rules and policies apply. The program runs through December 2027.
Eligibility
- Medicare Part D or Medicare Advantage plan
- Patients who are not on GLP-1s must have one of the following: a BMI of 35 or higher for weight management alone, a BMI of 30 with severe comorbidities like uncontrolled hypertension or heart failure, or a BMI of 27 alongside conditions like prediabetes or a history of stroke
For patients currently on GLP-1s, eligibility is based on their health data before they started therapy.
Process
Instead of writing a regular prescription, practitioners must submit an approval request to the pharmacy, which will be reviewed by the Medicare team. An obesity diagnosis code must be included, and the notes must carry these instructions: “SEND TO BRIDGE FOR WEIGHT MANAGEMENT.”
Once approved, the patient is notified. They will pay a $50 copay for each 30-day prescription.
The bridge program is an important step forward in ensuring equitable access to care for all Americans. For more information, visit the American Medical Women’s Association page on obesity care, the Obesity Care Action Network (OCAN), which has developed a tool kit to help practitioners, patients, and pharmacists navigate this new process, including an infographic detailing the patient journey, and the Centers for Medicare and Medicaid Services.
This essay is cited in the KevinMD record on GLP-1 drugs.
Eliza Lo Chin, MD, MPH is an internal medicine physician and the executive director of the American Medical Women’s Association.
The American Medical Women’s Association (AMWA) is the oldest multispecialty organization dedicated to advancing women physicians and improving the health of women. For more than a century, AMWA has been the vision and voice of women in medicine, pursuing its mission through leadership, advocacy, education, mentorship, and strategic partnerships.
AMWA has a long publishing history. Its members produced a series of consumer health references in the 1990s, including The Women’s Complete Health Book (Delacorte Press, 1995), the AMWA Guide to Pregnancy and Childbirth (1996), the AMWA Guide to Cardiovascular Health (1997), and The Complete Family Health Book (1999). The association’s flagship scholarly publication, the Journal of the American Medical Women’s Association (JAMWA), ran from 1946 to 2005 and grew out of earlier titles that trace back to the Bulletin of the Medical Women’s National Association, first published in 1922.
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