Eligibility for Anti-Obesity Medications through Medicare for Older Adults with Overweight or Obesity

Medicare covered anti-obesity medications (AOMs) only for type 2 diabetes until March 2024, when the agency announced that AOMs with additional indications will be covered under Medicare Part D. Consequently, Medicare beneficiaries with overweight or obesity can be eligible for AOMs if they concurrently have type 2 diabetes or cardiovascular disease (CVD). To assess the potential impact of Medicare's March guidance, we estimated the number of US adults aged ≥65 years with overweight or obesity who were eligible for Medicare coverage of AOMs before and after Medicare's March 2024 guidance, stratified by sociodemographic status. We pooled data from the National Health and Nutrition Examination Survey from January 2011 to March 2020, including participants aged ≥65 years with a BMI ≥27 kg/m2. The study sample included 3,385 participants aged ≥65 with overweight or obesity, representing 26,552,194 adults. Among this population, 45.8% (95% CI, 43.4-48.2) or 12.2 million people had diabetes or cardiovascular disease and were eligible for AOMs through Medicare post-March 2024. In contrast, 33.8% (95% CI, 31.6-36.0%) or 9.0 million people had diabetes and were eligible for AOMs through Medicare pre-March 2024. Older age, male sex, and White race were associated with greater expansion in AOM eligibility due to Medicare's March guidance. Older age, male sex, identifying as a minority race/ethnicity, lower income, and less education were associated with greater AOM eligibility rates post-March 2024. These findings demonstrate that across sociodemographic groups Medicare's guidance significantly expanded the population of beneficiaries eligible for AOMs, but about half of older adults with overweight or obesity remain ineligible for AOMs through Medicare.