Prevalence of Obesity and Related Conditions and GLP-1 Use in Medicare Fee-for-Service Beneficiaries

This study estimated the number and percentage of Medicare fee-for-service (FFS) beneficiaries who use GLP-1 RAs, are currently eligible or could become eligible if ongoing-trial indications receive approval and coverage.

This retrospective cohort study used Medicare enrolment and claims data, representing 100% of Medicare FFS beneficiaries. The study period was 1 January 2023 through 31 December 2024. Patients aged ≥ 18 years at the beginning of the study period who were alive and continuously enrolled in Medicare FFS Parts A, B and D for all 24 months were included.

Among Medicare FFS beneficiaries with Part D (n = 16 474 786), 6.2% had GLP-1 RAs. Overall, 35.1% had a currently covered GLP-1 indication (Type 2 diabetes, established cardiovascular disease with overweight/obesity, obstructive sleep apnoea with obesity or metabolic dysfunction-associated steatohepatitis). Among beneficiaries with a condition currently covered by Medicare, only 16.5% had a claim for a GLP-1 RA. In total, 76.9% had ≥ 1 currently covered or potential future indication. An estimated 1.2 million (7.0%) had obesity alone and were ineligible under current policy. If Medicare covered heart failure with preserved ejection fraction, chronic kidney disease, psoriasis and/or knee osteoarthritis, 35% of these currently ineligible beneficiaries (n = 407 085) could gain access.

Coverage via secondary conditions may broaden potential access to anti-obesity medications for Medicare FFS patients, but eligibility alone may not translate into actual treatment uptake unless affordability and other barriers are addressed. Further studies should quantify net benefits and costs of AOMs in Medicare FFS.