Expanding Medicare Part D Coverage of Weight Loss Medications: The Impact on Plastic Surgery

Obesity affects more than 40% of US adults and increases the risk of other conditions such as diabetes, cancer, and heart disease.1 Considering the medical and economic costs associated with obesity, interest in weight loss management has increased over the last 2 decades with advances in lifestyle counseling and bariatric surgery. Patients who achieve massive weight loss (MWL) are often left with skin redundancy, dysfunction, and deformity that can be treated with plastic surgery. Herein, we discuss the rising demand for weight loss medications and its impact on practice patterns in plastic surgery. Until recently, medications to treat obesity were limited. Those that were available, including phentermine, topiramate, bupropion, and naltrexone, had minimal efficacy and received poor evidence ratings as obesity treatments. In 2021, the Food and Drug Administration (FDA) approved semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, for chronic weight management. Semaglutide is administered in a once weekly injection and works by regulating appetite, blood sugar, insulin, and stomach emptying. Although drugs of the same class had been approved for diabetes, this was the first GLP-1 receptor agonist approved for weight loss. In clinical trials, semaglutide produced 10% to more than 20% weight loss in 6 months.1,2 Some private insurers cover semaglutide for weight loss after prior authorization. However, Medicare, the largest payer in the US, has a strict policy regarding covering prescriptions for weight loss and obesity. The Treat and Reduce Obesity Act introduced in March 2021 seeks to expand Medicare Part D coverage to include weight loss medications. Momentum for passage of this legislation has gained traction recently as the body of literature supporting the efficacy of semaglutide continues to grow. To understand trends in public interest for weight loss medications, we used Google Trends (Google, Mountain View, CA) to access search data histories for the term “semaglutide.” Interest level was reported in a relative measure, with 100 assigned to the week with the highest number of searches for semaglutide. Interest in semaglutide peaked during the week of March 19 to 25 in 2023 (Figure 1). Between March 2022 and March 2023, interest in semaglutide increased by 80.0 relative percentage points. The United States ranks fourth worldwide in relative interest, after Canada, Brazil, and Australia. Within the United States, search interest for semaglutide was concentrated in the South and Southeast (Figure 2). The states with the most interest were Mississippi, Louisiana, and West Virginia. The most common related topics searched were “GoodRx” and “shortage,” likely referring to opportunities for cost savings given the high price of the medication and the Ozempic (Novo Nordisk, Bagsværd, Denmark) shortage announced by the FDA in fall 2022. Google search interest in semaglutide over the past 5 years. Data source: Google Trends (www.google.com/trends). National trends in public interest in semaglutide. Darker shading indicates higher relative public interest. Data source: Google Trends (www.google.com/trends). Previous studies have validated Google Trends as a tool for predicting public interest and growth in case volume for certain plastic surgery procedures.3 Our results suggest that utilization of weight loss medications will continue increasing, especially with expansion of coverage through Medicare Part D. With more patients taking medications as part of multimodal weight loss treatments, the burden of skin redundancy and associated diseases such as intertrigo will also increase. To address these concerns and improve long-term weight control, patients who have success with medications may desire body contouring procedures, paralleling the increase in postbariatric plastic surgery. According to statistics from The Aesthetic Society, between 2001 and 2021 the annual rates for body contouring procedures such as panniculectomy, brachioplasty, and thighplasty increased by 298%, from 87,553 to 348,863. Moreover, patients over age 60 were the fastest-growing age group undergoing body contouring procedures.4 Weight loss with semaglutide has also been associated with deflated skin envelopes, laxity, and volume loss on the face. Colloquially called “Ozempic face,” these undesirable effects can be managed with facial fat grafting, dermal fillers, and rhytidectomy after discontinuation of the medication. Expansion of Medicare Part D to include medications for weight loss and obesity treatment will have significant downstream effects on plastic surgery practices. Plastic surgeons, especially those in the South and Southeast, should prepare for increased demand in procedures for skin redundancy as access to weight loss medications improves. For many MWL patients, the goal of body contouring surgery will prioritize functional over cosmetic outcomes, especially for surgeries covered by health insurance. Certain risks such as poor wound healing due to nutritional deficiencies should be carefully evaluated before surgery. Accordingly, multidisciplinary care teams that include plastic surgeons should be established to optimize outcomes. Research shows that body contouring improves long-term quality of life in bariatric surgery patients; future studies should evaluate whether the same conclusions apply to patients who use weight loss medications.5 The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. The authors received no financial support for the research, authorship, and publication of this article.

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