Medicare to Cover Wegovy- A Cost-Benefit Analysis

Medicare currently provides health insurance to more than 65 million people in the United States. Medicare has not provided coverage of weight loss drugs. Until now.?

Earlier this month, the FDA expanded the approval for Wegovy to include people who are overweight or obese to reduce their risk of heart disease. Includes individuals with an increased risk of heart attack, stroke, or other serious cardiovascular problems. While Medicare is still not covering Wegovy for weight loss, most individuals who are overweight and obese have heart diseases such as high blood pressure and hypercholesterolemia. These diseases are heavily linked to modifiable diet and lifestyle risk factors.?

Generally, Medicare covers individuals 65 years of age or older. This population definitely needs special care and attention when it comes to weight loss drugs. The first thing that comes to my mind is the risk of malnutrition and loss of lean muscle mass without adequate intake, which can result from the mechanism of drugs such as Wegovy.

According to NBC News, the cost of Wegovy is so high that this could potentially bankrupt Medicare due to the high demand for weight loss drugs.?

Cost Breakdown-

Out-Of-Pocket Wegovy is $1200 per month out-of-pocket. The cost of a nutrition counseling session with a Registered Dietitian typically ranges between $100-200 for self-pay options.??

Insurance Coverage-

Medicare only covers nutritional counseling for patients who have been diagnosed with diabetes and/or renal disease. The counseling requires a doctor's referral and limits the number of hours per referral.

Cost-Benefit Analysis-

At this rate, you can potentially have approximately 12 sessions with a Registered Dietitian for the same cost as a month's prescription of Wegovy. If you met every 2 weeks, you could see a Dietitian for 6 months for the same cost of one month of Wegovy. The cost difference is obvious.

Weight loss drugs, like any medication, have potential side effects. The risks associated depend on their frequency and severity. Common side effects of Wegovy are: nausea, diarrhea, vomiting, constipation, stomach (abdomen) pain, headache, tiredness (fatigue), upset stomach, dizziness, feeling bloated, belching, gas, stomach flu, and heartburn. It's no secret that when you stop taking a weight loss drug, the weight loss stops. There is a strong potential for rebound weight gain towards a higher weight than your starting point. When you begin taking Wegovy, you may be signing up for life.?

There is virtually no risk associated with seeing a Registered Dietitian. But there are benefits. I have owned and operated a private practice nutrition company, Kelly's Choice, for 12 years. The transformations of our clients have been absolutely life changing, and our testimonials speak for themselves.?

My client Vicky lost 143 pounds through working with a Dietitian. She reversed her high blood pressure and hypercholesterolemia, dropping her LDL from 289 to 157. She was able to directly reduce her risk of heart disease through gradual and sustainable diet and lifestyle modifications that overtime, became second nature. When she stopped seeing a Dietitian, she was able to maintain her weight loss and sustain healthy blood pressure and cholesterol levels.

Through diet modifications, you can reduce the risk of cardiovascular events in the future. Nutrition education and counseling directly improves diet quality and has been proven to create long-term success. A lot of clients come to me with high cholesterol, seeking nutrition advice before beginning medication intervention, such as statins. Together, we have seen cholesterol levels decrease and blood pressure improve. All from the power of nutrition education. And the best thing about nutrition education is that it doesn't just go away. When you learn a healthier way to eat, you not only impact yourself, but the nutrition and health of generations to come.

It is also important to shed some light on the importance of lifestyle as well. And I'm not just talking about exercising. While daily movement is important for overall health in addition to heart health, we need not to overlook the importance of adequate sleep, stress management, healthy relationships, a sense of purpose & community have on our health.

You can also prevent chronic diseases, such as heart disease, before they occur. You can address modifiable risk factors, such as weight and activity level, before you start to see it show in your lab work or test results. You are in control of your health. And you can start today. ?

Book a Dietitian today- kellyschoice.org/booktoday