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

Sonia Kim; Andrea Barthel; Marlene Smurzynski; Joanna MacEwan

doi:10.1111/dom.71033

. 2026 Jun 25;28(9):8398–8406. doi: 10.1111/dom.71033

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

Sonia Kim ¹, Andrea Barthel ¹, Marlene Smurzynski ¹, Joanna MacEwan ^1,^✉

PMCID: PMC13449082 PMID: 42348175

ABSTRACT

Aims

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.

Materials and Methods

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.

Results

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.

Conclusions

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.

Keywords: GLP‐1, obesity care, obesity therapy, real‐world evidence

1. Introduction

The prevalence of obesity has been steadily increasing in the United States (US), and by 2030, nearly half of American adults (47.1%) are projected to be diagnosed with obesity (body mass index [BMI] ≥ 30 kg/m²) [1]. According to data from the National Health and Nutrition Examination Survey (NHANES) collected from 2017 to March 2020, the age‐adjusted prevalence of obesity among adults was 41.9% [2]. The prevalence of obesity has also increased among older adults. The Centers for Medicare & Medicaid Services' (CMS) chronic conditions data indicates that around 21% of all Medicare fee‐for‐service (FFS) beneficiaries had a diagnosis of obesity in 2019 compared to 6.2% in 2010 [3]. Obesity and related comorbidities, including Type 2 diabetes (T2D), cardiovascular disease (CVD) and obstructive sleep apnoea (OSA), have historically been associated with substantial clinical and economic burden [4, 5, 6]. Within the Medicare population, higher BMI is associated with a greater risk of cardiometabolic conditions, such as hypertension, T2D, metabolic syndrome and congestive heart failure, as well as elevated medication use and increased healthcare resource utilisation and costs [5]. Despite the burden, pharmacologic treatment options for obesity have been limited, especially for older adults [7].

Glucagon‐like‐peptide‐1 receptor agonists (GLP‐1 RAs) were originally developed to treat T2D by improving glycaemic control. More recently, GLP‐1 RAs have emerged as a novel and effective therapeutic class for managing obesity and its associated comorbidities. Currently, Wegovy (semaglutide) [8], Saxenda (liraglutide) [9] and Zepbound (tirzepatide) [10] have been approved by the US Food and Drug Administration (FDA) for weight management in adults with obesity or overweight with at least one obesity‐related comorbidity (ORC). Tirzepatide and semaglutide are also marketed for T2D under different brand names. In addition to supporting weight loss and glycaemic control, these anti‐obesity medications (AOMs) offer other health benefits and are also indicated for reducing cardiovascular risk [11], heart failure symptoms [12] and OSA [13].

Emerging evidence suggests substantial efficacy of GLP‐1 RAs across a broad range of indications, including but not limited to cardiovascular outcomes [11], heart failure with preserved ejection fraction (HFpEF) [12], metabolic dysfunction‐associated steatotic liver disease (MASLD) [14], knee osteoarthritis [15] and neurodegenerative disease [16]. While these products are FDA‐approved for multiple indications, including obesity, Medicare is currently prohibited from covering medications for weight management under its standard prescription benefit (Part D), as the statutory definition of a covered Part D drug excludes ‘agents when used for anorexia, weight loss and weight gain’ [17]. Although Part D does not cover AOMs when used solely for chronic weight management, Medicare will cover the AOM if the patient has an additional medically accepted condition and labelled indication. For example, in March 2024, Medicare Part D began covering Wegovy following its approval to reduce the risk of major adverse cardiovascular events (MACE) in patients with either obesity or overweight who also have established CVD. Similarly, in January 2025, Zepbound became eligible for Part D coverage following its approval for treating OSA in patients with obesity or overweight.

In November 2024, CMS proposed to reinterpret the statutory exclusionary language to potentially expand Part D coverage for AOMs for weight loss or chronic weight management, a step that would significantly increase access to AOMs among Medicare and Medicaid enrolees. On 4 April 2025, as part of the 2026 Medicare Part D Final rule, CMS announced that AOMs would not be covered at this time. The agency noted, however, that it may revisit the proposal in future rulemaking. This proposed reinterpretation reflects a shifting landscape towards obesity treatment and increased potential for expanded access for Medicare and Medicaid enrolees.

Given the anticipated expansion of FDA‐approved/labelled indications for GLP‐1 RAs and the number of other AOMs in development [18] and the potential for future CMS reimbursement, it is critical to estimate how many Medicare FFS patients currently utilise GLP‐1 RAs and how many more may become eligible in the future as additional indications receive FDA approval. Using retrospective Medicare claims data, this study estimated the number and percentage of Medicare beneficiaries who utilise GLP‐1 RAs, who are eligible for GLP‐1 RA treatment and who may become eligible if the conditions currently being assessed in clinical trials are approved and covered.

2. Materials and Methods

2.1. Data Sources and Study Design

This was a retrospective cohort study using Medicare enrolment and claims data accessed through the Chronic Conditions Warehouse (CCW) Virtual Research Data Center, representing 100% of Medicare FFS beneficiaries. The study period was 1 January 2023–31 December 2024.

2.2. Study Population

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 during the 2023 and 2024 calendar years were included in the study.

Patients were excluded if they were pregnant at any time during the study period or had data anomalies, including age > 110 years, unknown sex or missing or invalid dates for birth or death.

2.3. Study Measures

The study evaluated demographic characteristics, including age, sex, race and region, for Medicare FFS enrolees captured at the start of the study period. The study assessed prevalence and co‐prevalence across three main cohorts of interest: (1) patients with at least one indication currently covered under Medicare Part D for GLP‐1 RAs and have obesity (BMI ≥ 30.0 kg/m²) or overweight (BMI ≥ 25.0 kg/m²) with at least one ORC (i.e., hyperlipidaemia, hypertension, osteoarthritis or OSA); (2) patients with at least one of the currently covered indications and have other additional conditions that may become eligible under potential future expansions; and (3) patients without any currently reimbursable indications. GLP‐1 RAs evaluated in the study include semaglutide (Wegovy, Ozempic), liraglutide (Saxenda, Victoza), dulaglutide (Trulicity), tirzepatide (Zepbound, Mounjaro), exenatide (Byetta, Bydureon), lixisenatide (Adlyxin) and albiglutide (Tanzeum).

The study defined indications that can be covered under Medicare Part D for GLP‐1 RAs as T2D, established CVD (i.e., defined as having prior myocardial infarction, stroke or peripheral arterial disease), OSA or MASH. Potential future indications were defined as indications currently being evaluated in clinical trials using the CT.gov database (as of April 2026) (Table S1). These potential indications were categorised as Phase 1, Phase 2 or Phase 3 according to the most advanced clinical trial phase available for each indication. All indications of interest were identified using the International Classification of Diseases, Clinical Modification, 10th Revision (ICD‐10‐CM) and GLP‐1 RA prescription claims were identified using National Drug Codes (NDC).

2.4. Statistical Analysis

Baseline characteristics were assessed descriptively. Categorical data were presented using frequencies and percentages. For continuous data, means, standard deviations, medians and 25th and 75th percentiles were presented. Prevalence, reported as a percentage, was calculated as the number of Medicare beneficiaries with conditions of interest at any point in 2023 and 2024 divided by the total number of Medicare beneficiaries who were continuously enrolled during 2023 and 2024. The overall cohort was stratified by age group (≥ 65 vs. < 65). Sensitivity analyses were conducted, comparing overweight definitions using BMI cutoffs of ≥ 25 and ≥ 27 kg/m², as well as assessing GLP‐1 RA utilisation in 2023 and 2024 among (1) overall population, (2) patients with T2D and (3) patients who had at least one Medicare covered indication to evaluate potential shortage‐period trends.

3. Results

3.1. Patient Demographics

After applying study inclusion and exclusion criteria, 16 474 786 patients with Parts A, B and D coverage were included. Of these patients, 6.2% (n = 1 014 947) had GLP‐1 prescription claims (Figure 1). When stratified by age, a higher proportion of patients in the < 65‐year cohort (n = 163 702) had GLP‐1 RAs compared with those in the ≥ 65‐year cohort (n = 851 245): 10.2% versus 5.7%, respectively. In the overall cohort, mean age at the start of the study period was 72.4 years old; most patients were White (83.0%; based on RTI race code) and females were slightly more represented (56.9%). The majority of patients were from the South (35.7%), followed by the Midwest (22.9%) and the West (21.3%) regions (Table S2).

Attrition flowchart. FFS, fee‐for‐service; GLP‐1 RA, glucagon‐like peptide‐1 receptor agonist.

3.2. Prevalence of Patients With Medicare Coverage Indications and/or Obesity or Overweight

Of the 16 474 786 beneficiaries, 27.1% had a diagnosis of T2D and 10.3% had a diagnosis of T2D and obesity (Figure 2). Among patients with T2D only, 20.6% had prescription claims for GLP‐1 RAs, compared with 30.9% among those with both T2D and obesity (Figure S1). A comparable share of beneficiaries had established CVD with overweight or obesity (11.3%) and only 13.5% of these patients had GLP‐1 RAs. In addition, 7.0% had both OSA and obesity, of whom 21.1% had GLP‐1 RAs. MASH was identified only in 0.5%, but 22.9% had GLP‐1 RAs. Overall, 35.1% had any combination of these conditions (T2D, established CVD with overweight or obesity, or OSA with obesity or MASH), but only 16.5% of these patients had GLP‐1 RAs.

Prevalence of Medicare Part D‐covered diagnoses and/or overweight or obesity in Medicare FFS beneficiaries with Part D, N = 16 474 786. CVD, cardiovascular disease; FFS, fee‐for‐service; GLP‐1 RA, glucagon‐like peptide‐1 receptor agonist; OSA, obstructive sleep apnoea; T2D, Type 2 diabetes.

After stratification by age, T2D prevalence was similar among beneficiaries aged ≥ 65 and < 65 years: 27.0% and 27.1%, respectively (Figure S2). However, the proportion of patients with GLP‐1 RA claims was higher in the < 65‐year cohort than in the ≥ 65‐year cohort: 33.2% versus 19.2%, respectively (Figure S3). This pattern was generally consistent across other Medicare coverage indications, where diagnosis prevalence was comparable by age, but GLP‐1 RA use was higher among beneficiaries aged < 65 years.

See Table S3 for additional details.

3.3. Prevalence of Patients With Medicare Coverage Indications and Potential Future Indications for AOMs

Among the 16 474 786 beneficiaries, 76.9% had at least one Medicare‐covered indication for GLP‐1 RAs (i.e., T2D, established CVD with overweight or obesity, OSA with obesity or MASH or at least one potential future indication across any clinical trial Phase) (Table 1). Of these patients, 7.9% had GLP‐1 RAs. After stratification by age, a lower proportion of beneficiaries aged < 65 years had Medicare coverage indications or potential future indications compared with those aged ≥ 65 years: 69.1% versus 77.7%, respectively. However, GLP‐1 RA prescription claims were more common in the < 65‐year cohort than in the ≥ 65‐year cohort: 14.5% versus 7.3%, respectively.

TABLE 1.

Prevalence of Medicare coverage indications and potential indications in the overall population and age‐stratified cohorts.

Category	Overall population		Age < 65 years old		Age ≥ 65 years old
Category	N (%)	Patients with GLP‐1 claims, N (%)	N (%)	Patients with GLP‐1 claims, N (%)	N (%)	Patients with GLP‐1 claims, N (%)
Overall population	16 474 786	1 014 947 (6.2%)	1 603 766	163 702 (10.2%)	14 871 020	851 245 (5.7%)
T2D+ ≥ 1 potential indications
Potential indications (any phase)	3 667 995 (22.3%)	762 354 (20.8%)	354 736 (22.1%)	120 395 (33.9%)	3 313 259 (22.3%)	641 959 (19.4%)
Potential indications (Phase 1)	1 447 102 (8.8%)	249 542 (17.2%)	146 235 (9.1%)	45 224 (30.9%)	1 300 867 (8.8%)	204 318 (15.7%)
Potential indications (Phase 2)	2 338 021 (14.2%)	496 354 (21.2%)	252 731 (15.8%)	88 291 (34.9%)	2 085 290 (14.0%)	408 063 (19.6%)
Potential indications (Phase 3)	2 881 472 (17.5%)	611 266 (21.2%)	251 480 (15.7%)	86 959 (34.6%)	2 629 992 (17.7%)	524 307 (19.9%)
T2D or (established CVD with overweight ≥ 25.0 or obesity) or (OSA with obesity) or MASH or ≥ 1 potential indications
Potential indications (any phase)	12 664 870 (76.9%)	1 004 061 (7.9%)	1 108 324 (69.1%)	161 082 (14.5%)	11 556 546 (77.7%)	842 979 (7.3%)
Potential indications (Phase 1)	9 259 008 (56.2%)	988 820 (10.7%)	782 042 (48.8%)	156 987 (20.1%)	8 476 966 (57.0%)	831 833 (9.8%)
Potential indications (Phase 2)	9 532 311 (57.9%)	981 681 (10.3%)	922 529 (57.5%)	157 716 (17.1%)	8 609 782 (57.9%)	823 965 (9.6%)
Potential indications (Phase 3)	9 414 580 (57.2%)	978 222 (10.4%)	756 801 (47.2%)	155 049 (20.5%)	8 657 779 (58.2%)	823 173 (9.5%)
T2D or (established CVD with overweight ≥ 27.0 or obesity) or (OSA with obesity) or MASH or ≥ 1 potential indications
Potential indications (any phase)	12 649 747 (76.8%)	1 004 004 (7.9%)	1 107 313 (69.0%)	161 072 (14.6%)	11 542 434 (77.6%)	842 932 (7.3%)
Potential indications (Phase 1)	9 158 099 (55.6%)	988 517 (10.8%)	776 770 (48.4%)	156 947 (20.2%)	8 381 329 (56.4%)	831 570 (9.9%)
Potential indications (Phase 2)	9 451 671 (57.4%)	981 313 (10.4%)	918 910 (57.3%)	157 690 (17.2%)	8 532 761 (57.4%)	823 623 (9.7%)
Potential indications (Phase 3)	9 367 002 (56.9%)	977 963 (10.4%)	753 547 (47.0%)	155 021 (20.6%)	8 613 455 (57.9%)	822 942 (9.6%)
Patients with obesity alone without Medicare coverage indications
Obesity alone without Medicare coverage indications	1 155 645 (7.0%)	33 302 (2.9%)	181 384 (11.3%)	8872 (4.9%)	974 261 (6.6%)	24 430 (2.5%)

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Abbreviations: CVD, cardiovascular disease; GLP‐1, glucagon‐like peptide‐1; MASH, metabolic dysfunction‐associated steatohepatitis; OSA, obstructive sleep apnoea; T2D, Type 2 diabetes.

3.4. Phase 1 Indications

Overall, 56.2% had at least one Medicare‐covered indication or Phase 1 potential indication; among these patients, 10.7% had GLP‐1 RAs (Table 1). Prediabetes was the most common Phase 1 indication, identified in 23.6% of patients (Figure 3), of whom 4.3% had GLP‐1 RAs (Figure S4). COPD was also common, identified in 12.9% of patients, of whom 7.7% had GLP‐1 RAs. Similar patterns were observed in the age‐stratified cohorts, with a higher proportion of GLP‐1 RA claims observed among beneficiaries aged < 65 years (Figures S5 and S6).

Prevalence of potential future indications in Medicare FFS beneficiaries with Part D, N = 16 474 786. CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; FFS, fee‐for‐service; HFpEF, heart failure with preserved ejection fraction; MAFLD, metabolic‐associated fatty liver disease; MASH, metabolic dysfunction‐associated fatty liver disease; MDD, major depressive disorder; PCOS, polycystic ovary syndrome; T1D, Type 1 diabetes.

3.5. Phase 2 Indications

Overall, 57.9% had at least one Medicare covered indication or Phase 2 potential indication; of these, 10.3% had GLP‐1 RAs (Table 1). MDD was the most common, identified in 18.5% of patients (Figure 3) (9.0% with GLP‐1 RAs; Figure S4). This was followed by atrial fibrillation, identified in 14.9% (7.2% with GLP‐1 RAs). Although polycystic ovary syndrome (PCOS) was identified in only 0.1%, 25.4% of these patients had GLP‐1 RAs. After stratification by age, MDD remained the most common Phase 2 indication in the < 65‐year cohort; 14.2% had GLP‐1 RA claims. Asthma appeared as the second most common Phase 2 indication in this cohort, identified in 11.8%, of whom 17.1% had GLP‐1 RA claims (Figures S5 and S6).

3.6. Phase 3 Indications

Overall, 57.2% had at least one Medicare covered indication or Phase 3 potential indication (10.4% had GLP‐1 RAs) (Table 1). Among Phase 3 indications, CKD was the most common, identified in 20.5% of patients (Figure 3), of whom 11.2% had GLP‐1 RAs (Figure S4). Peripheral artery disease was identified in 14.9% of patients, of whom 9.1% had GLP‐1 RAs and knee osteoarthritis was identified in 13.5% of patients, of whom 8.2% had GLP‐1 RAs. The next anticipated indication for AOM coverage is HFpEF (6.3% prevalence, 10.3% with GLP‐1 RAs). While metabolic‐associated fatty liver disease (MAFLD), Type 1 diabetes (T1D) and psoriasis were less common (MAFLD: 3.2%; T1D: 1.1%; psoriasis: 1.8%), they showed a comparatively higher proportion of GLP‐1 RA claims (MAFLD: 16.0%; T1D: 19.2%; psoriasis: 9.1%) relative to other Phase 3 potential indications.

Lower prevalences of Phase 3 indications were observed in the < 65‐year cohort compared with the ≥ 65‐year cohort, except for HFpEF, MAFLD and psoriasis (Figure S5). However, across all Phase 3 indications, the proportion of patients with GLP‐1 RA claims was consistently higher among beneficiaries aged < 65 years than among those aged ≥ 65 years (Figure S6).

3.7. Prevalence of Patients Without Diagnoses Currently Covered Under Medicare AOM Coverage

Of the 16 474 786 beneficiaries, 7.0% (n = 1 155 645) had obesity alone without another FDA‐approved and Medicare covered indicated condition, that is, established CVD, T2D, OSA or MASH (Table S4). Among these patients with indications that may be approved in the near term, 4.0% had HFpEF, 15.4% had CKD, 2.2% had psoriasis and 19.8% had knee osteoarthritis. In other words, if Medicare coverage were expanded to include HFpEF, CKD, psoriasis and/or knee osteoarthritis, approximately 35.2% of individuals (N = 407 085) who are currently ineligible due to the lack of a qualifying condition can gain access to these AOMs (Figure 4). See Table S4 for additional details.

Prevalence of select potential indications in Medicare FFS beneficiaries with Part D with obesity and without any covered conditions. CKD, chronic kidney disease; FFS, fee‐for‐service; HFpEF, heart failure with preserved ejection fraction. ^†Obesity alone is defined as obesity without any of the Medicare‐reimbursable conditions for anti‐obesity drugs.

3.8. Sensitivity Analyses

Sensitivity analyses using BMI cutoffs of ≥ 25 kg/m² versus ≥ 27 kg/m² showed minimal differences, suggesting that the study findings were not meaningfully affected by the choice of overweight BMI threshold (Table S3). In year‐specific analyses, GLP‐1 RA utilisation increased from 2023 to 2024 across key subgroups (Table S5).

4. Discussion

4.1. Key Results Among Medicare FFS Beneficiaries With Part D Coverage

While more than one in three (35.1%) Medicare FFS beneficiaries with Part D coverage had a GLP‐1 approved condition currently covered by Medicare, GLP‐1 RA use remained limited. Overall, 6.2% of all beneficiaries had a claim for a GLP‐1 RA. Among beneficiaries with a condition currently covered by Medicare, only 16.5% had a claim for a GLP‐1 RA.

About one in five (20.6%) with an indication of T2D had GLP‐1 RA claims and 76.9% of beneficiaries had at least one FDA‐approved condition for a GLP‐1 or a condition under investigation as a potential future indication. More than half of beneficiaries had conditions represented in each clinical trial Phase category: 56.2% for Phase 1, 57.9% for Phase 2 and 57.2% for Phase 3. Prediabetes, MDD and CKD were among the most common Phase 1, Phase 2 and Phase 3 conditions, respectively. While 7.0% had obesity alone and thus were ineligible due to the lack of a qualifying covered condition, 35.2% of individuals (N = 407 085) who are currently ineligible due to the lack of a qualifying condition can gain access to these AOMs if Medicare coverage expanded to include HFpEF, CKD, psoriasis and/or knee osteoarthritis.

Our findings suggest that future indication approvals could substantially increase the number of beneficiaries who are potentially eligible for GLP‐1 RAs and other AOMs. However, the low observed GLP‐1 RA use even among beneficiaries with currently covered indications highlights the presence of additional and likely larger barriers, including cost, complex prior authorisation procedures, drug shortages or prescriber awareness, limiting the actual treatment uptake. Therefore, the treatment uptake under future Medicare coverage expansion will likely depend on whether these affordability, administrative and clinical barriers to access [19] are addressed to optimise obesity pharmacotherapy use.

4.2. Comparison to Existing Literature

To our knowledge, the current study is the first real‐world study using Medicare FFS claims data that comprehensively assesses the percentage of Medicare FFS beneficiaries who are currently eligible for GLP‐1 RAs, beneficiaries who may be additionally eligible under potentially expanded indications, and beneficiaries with obesity who may gain access because they have conditions that are the subject of ongoing clinical trials for GLP‐1 RAs. A prior study using NHANES survey data reported low utilisation of AOMs [20], which is consistent with our findings in the Medicare population. Our findings have clear fiscal implications. Prior studies [21, 22, 23] indicated that Medicare Part D coverage of GLP‐1s to treat obesity can lead to a substantial increase in future Medicare spending, but estimates vary due to key differences in assumptions regarding the eligible population, medication costs and treatment uptake and adherence [22]. Ippolito and Levy [23] estimated that expanding Medicare coverage of AOMs can increase annual spending by $3.1–$6.1 billion and Hwang et al. [22] projected Medicare's net spending would increase by $47.7 billion.

These projected costs should be weighed against the clinical benefits of AOMs. Dayer et al. [24] estimated that over a 10‐year period, broad access to semaglutide could avert 38 950 cardiovascular events and 6180 deaths through reduction in cardiovascular events and delayed CKD or MASH progression, yielding net savings of $1.04 billion and $412 million over those 10 years. Ward et al. [25] estimated that Medicare coverage of AOMs would save the programme $175–$245 billion over 10 years. These findings suggest that policymakers should consider clinical benefits alongside costs when evaluating broader access to AOMs. The current challenge in treating obesity among the Medicare population is access, as Medicare is specifically prohibited from covering medications solely for weight management. However, this analysis indicates that expanding coverage to include HFpEF, CKD, psoriasis and/or knee osteoarthritis would extend access to approximately 35% of beneficiaries with obesity who currently do not have another qualifying condition. More patients will be eligible for AOMs based on the labelling if ongoing clinical trials trigger additional approvals in the coming years. The net fiscal effect remains uncertain; yet coverage of secondary conditions may serve as an important step towards broadening access to these effective treatments. Recently approved oral obesity drug pills (Rybelsus and Foundayo) and emerging drugs, such as triple‐hormone‐receptor agonists and amylin analogues, are expected to intensify market competition. In addition, price negotiations under the Inflation Reduction Act [26] may potentially lower the treatment cost, further facilitating broader access to AOMs in the near term. Emerging direct‐to‐consumer programmes can additionally improve drug access; however, these programmes can accentuate disparities in treatment access, especially in rural areas. Ensuring equitable access to these therapies within an evolving policy and reimbursement landscape remains an important area for future research.

This study was conducted using Medicare FFS claims data, with over 16 million beneficiaries and is a national dataset of US individuals aged ≥ 65 years old and/or those with qualifying disability. However, our study is subject to limitations. The current study did not include the Medicare Advantage population, and as Medicare Advantage serves more low‐income individuals [27], has a higher share of racial minorities [28] and accounts for more than half of all Medicare enrolees [29], the FFS population may not be fully representative of the broader Medicare population. Claims data are primarily designed for billing and may contain inaccuracies due to coding errors, missing entries or misclassified diagnoses and procedures, which could introduce bias. ICD‐10‐CM codes for obesity have historically been underutilised [30, 31]. This could underestimate the size of the eligible population and the potential number of beneficiaries who may become eligible under expanded indications. In addition, claims data often lack comprehensive clinical details (e.g., laboratory measurements and condition severity). Although overweight was defined using BMI ≥ 25 kg/m², consistent with the standard clinical definition, this threshold is broader than the BMI ≥ 27 kg/m² cutoff commonly used in AOM clinical trials. Therefore, using BMI ≥ 25 kg/m² could potentially overestimate the number of beneficiaries who may become eligible. However, our sensitivity analysis results showed minimal differences, suggesting that the study findings were not meaningfully impacted by the choice of overweight BMI threshold. Given many diagnoses were defined using CCW‐derived chronic condition indicators that rely on claims observed over a 2‐year lookback period, we required 2 years of continuous enrolment to ensure adequate capture of these conditions. As a result, our study sample may be skewed towards healthier beneficiaries, excluding sicker patients who died. Finally, our data cutoff was 31 December 2024, overlapping with semaglutide and tirzepatide shortages from late 2022 to early 2025. The observed increase in GLP‐1 RA utilisation from 2023 to 2024 suggests that utilisation estimates may have been impacted by GLP‐1 RA shortages. Our estimates of GLP‐1 RA utilisation may not fully reflect more recent trends as drug availability and AOM coverage policies have continued to evolve. Finally, our estimates approximate the number of patients with claims‐observed indications for GLP‐1 RAs and should not be interpreted as definitive measures of clinical eligibility or actual access. Real‐world coverage and access depend on other important factors, including cost‐sharing, prior authorisations, prescribing patterns and drug availability.

5. Conclusion

More than one in three Medicare FFS beneficiaries with Part D coverage had a GLP‐1‐approved condition currently covered by Medicare; of these, only approximately one in six had a claim for a GLP‐1 RA. While uncertainty in the regulatory, legislative and reimbursement landscapes for AOMs still persists, emerging evidence suggests substantial efficacy of GLP‐1 RAs across a broad range of indications [32] and potential savings from improved health [24, 25]. Coverage via secondary conditions may serve as an important pathway to broaden potential access to AOMs among Medicare beneficiaries who are currently ineligible based on obesity alone. However, expanded eligibility must be accompanied by efforts to address bigger challenges around affordability and other barriers to access for potential eligibility to translate into actual treatment uptake. Further research should assess the benefits and costs of GLP‐1 RAs and other AOMs in the Medicare FFS beneficiaries.

Funding

The authors have nothing to report.

Conflicts of Interest

Sonia Kim, Andrea Barthel, Marlene Smurzynski and Joanna MacEwan are all employees of Genesis Research Group, a consultancy to the life sciences industry. Given the relevance of GLP‐1 receptor agonist therapies to the pharmaceutical and healthcare sectors, this affiliation may be perceived as a potential conflicts of interest. The authors affirm that the study was conceived, conducted and reported according to established scientific and methodological standards and the findings and interpretations presented are based on the available evidence.

Supporting information

Table S1: Potential indications not currently approved but may potentially qualify for reimbursement in the future.

Table S2: Baseline characteristics of current Medicare Part D beneficiaries.

Figure S1: Utilization of Medicare Part D prescription claims for GLP‐1 RAs in Medicare FFS beneficiaries with Part D with Medicare coverage indications and/or obesity or overweight.

Figure S2: Prevalence of Medicare Part D covered diagnoses and/or obesity or overweight in Medicare FFS beneficiaries with Part D, age‐stratified.

Figure S3: Utilization of Medicare Part D prescription claims for GLP‐1 RAs in Medicare FFS beneficiaries with Part D with Medicare coverage indications, age‐stratified.

Figure S4: Utilization of Medicare Part D prescription claims for GLP‐1 RAs in Medicare FFS beneficiaries with Part D among patients with potential future indications.

Figure S5: Prevalence of potential future indications in Medicare FFS beneficiaries with Part D, age‐stratified.

Figure S6: Utilization of Medicare Part D prescription claims for GLP‐1 RAs in Medicare FFS beneficiaries with Part D among patients with potential future indications, age‐stratified.

Table S3: Prevalence of Medicare coverage indications in the overall population and age‐stratified cohorts.

Table S4: Prevalence of anticipated near term indications among patients with obesity alone.

Table S5: Estimates of GLP‐RA utilization in 2023 versus 2024.

DOM-28-8398-s002.docx^{(281.2KB, docx)}

Data S1: Supplementary file_codelist.

DOM-28-8398-s001.xlsx^{(652.7KB, xlsx)}

Acknowledgements

The authors thank Junhui Zhao and Kristen Downs for their contributions to the study.

Kim S., Barthel A., Smurzynski M., and MacEwan J., “Prevalence of Obesity and Related Conditions and GLP‐1 Use in Medicare Fee‐for‐Service Beneficiaries,” Diabetes, Obesity and Metabolism 28, no. 9 (2026): 8398–8406, 10.1111/dom.71033.

Handling Editor: Richard Donnelly

Data Availability Statement

The data that support the findings of this study are available from the Centers for Medicare & Medicaid Services (CMS), but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are available from the authors upon reasonable request and with permission of CMS.

References

1. Wang Y., Beydoun M. A., Min J., Xue H., Kaminsky L. A., and Cheskin L. J., “Has the Prevalence of Overweight, Obesity and Central Obesity Levelled Off in the United States? Trends, Patterns, Disparities, and Future Projections for the Obesity Epidemic,” International Journal of Epidemiology 49, no. 3 (2020): 810–823, 10.1093/ije/dyz273. [DOI] [PMC free article] [PubMed] [Google Scholar]
2. Stierman B., Afful J., Carroll M. D., et al., “National Health and Nutrition Examination Survey 2017‐March 2020 Prepandemic Data Files‐Development of Files and Prevalence Estimates for Selected Health Outcomes,” National Health Statistics Reports 158 (2021): 1, 10.15620/cdc:106273. [DOI] [PMC free article] [PubMed] [Google Scholar]
3. Centers for Medicare & Medicaid Services (CMS) , “Data Snapshot: Obesity and Medicare Beneficiaries,” 2023, https://www.cms.gov/files/document/omh‐datasnapshot‐obesity.pdf.
4. Ezendu K., Pohl G., Lee C. J., Wang H., Li X., and Dunn J. P., “Prevalence of Obesity‐Related Multimorbidity and Its Health Care Costs Among Adults in the United States,” Journal of Managed Care & Specialty Pharmacy 31, no. 2 (2025): 179–188, 10.18553/jmcp.2025.31.2.179. [DOI] [PMC free article] [PubMed] [Google Scholar]
5. Suehs B. T., Kamble P., Huang J., et al., “Association of Obesity With Healthcare Utilization and Costs in a Medicare Population,” Current Medical Research and Opinion 33, no. 12 (2017): 2173–2180, 10.1080/03007995.2017.1361915. [DOI] [PubMed] [Google Scholar]
6. Pearson‐Stuttard J., Banerji T., Capucci S., et al., “Real‐World Costs of Obesity‐Related Complications Over Eight Years: A US Retrospective Cohort Study in 28,500 Individuals,” International Journal of Obesity 47, no. 12 (2023): 1239–1246, 10.1038/s41366-023-01376-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
7. Žižka O., Haluzík M., and Jude E. B., “Pharmacological Treatment of Obesity in Older Adults,” Drugs & Aging 41, no. 11 (2024): 881–896, 10.1007/s40266-024-01150-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
8. U.S. Food and Drug Administration (FDA) , “Wegovy (Semaglutide) Injection, for Subcutaneous Use—Prescribing Information,” 2021, https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/215256s000lbl.pdf.
9. U.S. Food and Drug Administration (FDA) , “FDA Approves Weight Management Drug for Patients Aged 12 and Older,” 2020, https://www.fda.gov/drugs/news‐events‐human‐drugs/fda‐approves‐weight‐management‐drug‐patients‐aged‐12‐and‐older.
10. U.S. Food and Drug Administration (FDA) , “FDA Approves New Medication for Chronic Weight Management,” 2023, https://www.fda.gov/news‐events/press‐announcements/fda‐approves‐new‐medication‐chronic‐weight‐management.
11. Lincoff A. M., Brown‐Frandsen K., Colhoun H. M., et al., “Semaglutide and Cardiovascular Outcomes in Obesity Without Diabetes,” New England Journal of Medicine 389, no. 24 (2023): 2221–2232, 10.1056/NEJMoa2307563. [DOI] [PubMed] [Google Scholar]
12. Kosiborod M. N., Abildstrøm S. Z., Borlaug B. A., et al., “Semaglutide in Patients With Heart Failure With Preserved Ejection Fraction and Obesity,” New England Journal of Medicine 389, no. 12 (2023): 1069–1084, 10.1056/NEJMoa2306963. [DOI] [PubMed] [Google Scholar]
13. Malhotra A., Grunstein Ronald R., Fietze I., et al., “Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity,” New England Journal of Medicine 391, no. 13 (2024): 1193–1205, 10.1056/NEJMoa2404881. [DOI] [PMC free article] [PubMed] [Google Scholar]
14. Sanyal A. J., Newsome P. N., Kliers I., et al., “Phase 3 Trial of Semaglutide in Metabolic Dysfunction‐Associated Steatohepatitis,” New England Journal of Medicine 392, no. 21 (2025): 2089–2099. [DOI] [PubMed] [Google Scholar]
15. Bliddal H., Bays H., Czernichow S., et al., “Once‐Weekly Semaglutide in Persons With Obesity and Knee Osteoarthritis,” New England Journal of Medicine 391, no. 17 (2024): 1573–1583. [DOI] [PubMed] [Google Scholar]
16. Hong C.‐T., Chen J.‐H., and Hu C.‐J., “Role of Glucagon‐Like Peptide‐1 Receptor Agonists in Alzheimer's Disease and Parkinson's Disease,” Journal of Biomedical Science 31, no. 1 (2024): 102, 10.1186/s12929-024-01090-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
17. Centers for Medicare & Medicaid Services (CMS) , “Part D Drugs/Part D Excluded Drugs,” accessed July 8, 2025, https://www.cms.gov/medicare/prescription‐drug‐coverage/prescriptiondrugcovcontra/downloads/partddrugspartdexcludeddrugs.pdf.
18. Melson E., Ashraf U., Papamargaritis D., and Davies M. J., “What Is the Pipeline for Future Medications for Obesity?,” International Journal of Obesity 49, no. 3 (2025): 433–451, 10.1038/s41366-024-01473-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
19. Herges J. R., Neumiller J. J., and RG M. C., “Navigating Cost and Access Barriers for Medications in the Treatment of Obesity: A Guide for Patients and Primary Care Clinicians,” Clinical Diabetes 43, no. 4 (2025): 587–596, 10.2337/cd24-0115. [DOI] [PMC free article] [PubMed] [Google Scholar]
20. MacEwan J., Kan H., Chiu K., Poon J. L., Shinde S., and Ahmad N. N., “Antiobesity Medication Use Among Overweight and Obese Adults in the United States: 2015–2018,” Endocrine Practice 27, no. 11 (2021): 1139–1148, 10.1016/j.eprac.2021.07.004. [DOI] [PubMed] [Google Scholar]
21. Congressional Budget Office , “How Would Authorizing Medicare to Cover Anti‐Obesity Medications Affect the Federal Budget?,” 2024, https://www.cbo.gov/system/files/2024‐10/60441‐medicare‐coverage‐obesity.pdf.
22. Hwang J. H., Laiteerapong N., Huang E. S., Mozaffarian D., Fendrick A. M., and Kim D. D., “Fiscal Impact of Expanded Medicare Coverage for GLP‐1 Receptor Agonists to Treat Obesity,” JAMA Health Forum 6, no. 4 (2025): e250905, 10.1001/jamahealthforum.2025.0905. [DOI] [PMC free article] [PubMed] [Google Scholar]
23. Ippolito B. and Levy J. F., “Expanding Medicare Coverage of Anti‐Obesity Medicines Could Increase Annual Spending by $3.1 Billion to $6.1 Billion,” Health Affairs 43, no. 9 (2024): 1254–1262, 10.1377/hlthaff.2024.00356. [DOI] [PubMed] [Google Scholar]
24. Dayer V. W., Nourhussein I., Kasle A., Hansen R. N., Navas A., and Sullivan S. D., “Comprehensive Access to Semaglutide: Clinical and Economic Implications for Medicare,” Value in Health 28 (2025): 1488–1496, 10.1016/j.jval.2025.07.007. [DOI] [PubMed] [Google Scholar]
25. Ward A. S., Tysinger B., Nguyen P., Goldman D. P., and Lakdawalla D., Benefits of Medicare Coverage for Weight Loss Drugs , Schaeffer Center White Paper Series (USC Schaeffer, 2023).
26. Centers for Medicare & Medicaid Services , “HHS Announces 15 Additional Drugs Selected for Medicare Drug Price Negotiations in Continued Effort to Lower Prescription Drug Costs for Seniors,” 2025, https://www.cms.gov/newsroom/press‐releases/hhs‐announces‐15‐additional‐drugs‐selected‐medicare‐drug‐price‐negotiations‐continued‐effort‐lower.
27. AHIP , “New Analysis Shows Medicare Advantage Outperforms Fee‐for‐Service Medicare in Improving Patient Outcomes, Delivering Care at a Lower Cost,” 2025, https://www.ahip.org/news/articles/new‐analysis‐shows‐medicare‐advantage‐outperforms‐fee‐for‐service‐medicare‐in‐improving‐patient‐outcomes‐delivering‐care‐at‐a‐lower‐cost.
28. Better Medicare Alliance , “State of Medicare Advantage: The Latest Trends and Data for 2024,” 2024, https://bettermedicarealliance.org/blog‐posts/state‐of‐medicare‐advantage‐the‐latest‐trends‐and‐data‐for‐2024/.
29. Centers for Medicare & Medicaid Services (CMS) , “Medicare Monthly Enrollment,” 2026, https://data.cms.gov/summary‐statistics‐on‐beneficiary‐enrollment/medicare‐and‐medicaid‐reports/medicare‐monthly‐enrollment.
30. Mocarski M., Tian Y., Smolarz B. G., McAna J., and Crawford A., “Use of International Classification of Diseases, Ninth Revision Codes for Obesity: Trends in the United States From an Electronic Health Record‐Derived Database,” Population Health Management 21, no. 3 (2018): 222–230, 10.1089/pop.2017.0092. [DOI] [PMC free article] [PubMed] [Google Scholar]
31. Baser O., Baser E., and Samayoa G., “Relationship Between Body Mass Index and Diagnosis of Overweight or Obesity in Veterans Administration Population,” Health 11, no. 11 (2023): 1529, 10.3390/healthcare11111529. [DOI] [PMC free article] [PubMed] [Google Scholar]
32. Moiz A., Filion K. B., Tsoukas M. A., Yu O. H. Y., Peters T. M., and Eisenberg M. J., “The Expanding Role of GLP‐1 Receptor Agonists: A Narrative Review of Current Evidence and Future Directions,” EClinicalMedicine 86 (2025): 103363, 10.1016/j.eclinm.2025.103363. [DOI] [PMC free article] [PubMed] [Google Scholar]

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