Document Type
Student Note
Abstract
There are currently three options when it comes to managing obesity: (1) making nutritional and activity changes; (2) weight loss medications; and (3) weight loss surgery. The existing limited options for managing obesity are even more restricted for Medicare patients. Making lifestyle changes might not be effective for a variety of reasons, including persistent food cravings and experiences of weight stigma from healthcare providers. To qualify for weight loss surgery, Medicare patients must satisfy several criteria in addition to the already specific weight loss surgery requirements. Additionally, weight loss surgery might not be the most viable option for the Medicare population, which is made up of patients who are over the age of 65 or have a qualifying disability. Weight loss medications might be the better alternative for Medicare patients. However, Medicare Part D does not currently cover weight loss medications. This means that Medicare patients must pay out-of-pocket costs to receive these medications, which can be over $1,000 for a one-month supply. Currently, there are three options for Medicare Part D prescription drug coverage expansion. First, the Treat and Reduce Obesity Act of 2023 would expand Medicare Part D so that it would include coverage for weight loss medications. Second, there is potential for weight loss medications to be included as part of the future drug price negotiations included in the Inflation Reduction Act (“IRA”). Third, Medicare Part D can be expanded through either a national coverage determination (“NCD”) or local coverage determination (“LCD”). Given these three options, which is the best solution for a rural state like West Virginia? This Note discusses these options and argues a LCD would be the best solution for Medicare patients in West Virginia and other rural states. Following an introduction in Part I, this Note will provide a general overview of the obesity problem in Part II. Specifically, Part II will discuss the heightened risk of danger obese patients face and the current treatment options that are available to manage obesity. Additionally, Part II will generally explore how two of the current treatment options might not be suitable for patients and specifically discuss the treatment option that is likely not suitable for Medicare patients: weight loss surgery. Part II will argue how weight loss medications are likely a more suitable treatment option for Medicare patients. Second, Part III will discuss the three current options for expanding Medicare so that coverage includes weight loss medications: the Treat and Reduce Obesity Act of 2023, the Inflation Reduction Act of 2022, and national or local coverage determinations. Third, this Note examines the unique considerations that must be addressed to treat obese patients in rural states in Part IV, including the demographics of patients in West Virginia. Fourth, Part V will propose that the best solution for a rural state like West Virginia is likely seeking a LCD, and Part V provides guidance on how to apply for a LCD.
Recommended Citation
Emily Blackburn,
A Local Option: How Medicare Patients in Rural States Could Obtain Coverage for Weight Loss Medications,
127
W. Va. L. Rev.
231
(2024).
Available at:
https://researchrepository.wvu.edu/wvlr/vol127/iss1/10
