Maintaining a healthy weight is one of the cornerstones of achieving overall health. Obesity can lead to serious problems within the cardiovascular system, including high cholesterol, coronary artery disease, heart attack or stroke. Additionally, extra weight may lead to the development of diseases like cancer, and the stress that added body weight puts on bones and joints can lead to the breakdown of connective tissue over time.
Unfortunately, as people age, losing weight often becomes more difficult, and this can be compounded due to aching joints, increased fragility and decreased mobility with age. While you should always consult with your physician prior to adding to or changing an exercise routine or dietary regimen, you may also consider discussing weight loss medications like Qsymia to lose weight by changing the way the body and brain process hunger signals.
What is Qsymia?
Qsymia (phentermine and topiramate extended release) is a prescription drug developed by Vivus. It provides additional assistance to individuals who have found it difficult to lose weight or maintain a healthy weight by reducing appetite and diminishing cravings through the alteration of taste bud function.
Unlike some over-the-counter weight-loss supplements which reduce weight through bio-chemical reactions, Qsymia works with the brain’s pleasure center to remove the sensation achieved by indulging in tasty foods. The medication is believed to work well in conjunction with therapy in people who have been diagnosed with an eating disorder that leads to binge eating.
Medicare Coverage of Qsymia
Even though weight loss is important to holistic health, it is considered a lifestyle concern under Medicare insurance regulations, and therefore, weight loss medications like Qsymia are generally not covered. Medicare considers medical treatments that pertain to lifestyle as uncovered expenses because it is commonly believed that these treatments are not medically necessary, even if they can have a medical benefit. As a result, Medicare recipients are not covered for weight-loss medications, although surgery may be covered in some circumstances.
Because of this, Medicare benefits will typically not cover Qsymia under Part D, although the medication is available through retail pharmacies for self-administration to Medicare recipients. Additionally, Medicare Part B will not provide coverage for Qsymia, even when administered during outpatient treatment. Finally, Part A of Original Medicare benefits, the part that typically applies to hospitalization and skilled nursing facility care, will not provide coverage of Qsymia when the drug is administered during the course of an inpatient stay for treatment.
Qsymia and Medicare Advantage
Because Medicare recipients who have Medicare Advantage plans often receive additional benefits not found in Original Medicare, it is possible that your plan may provide assistance in paying for Qsymia or other treatments for conditions that Medicare views as related to lifestyle. On top of that, a Medicare Advantage plan may offer additional assistance in paying for drugs like Qsymia through discounts and negotiated deals with certain prescription drug manufacturers.
Finally, you may receive a discount on Qsymia through a Medicare Advantage plan via discounted premiums, deductibles or reimbursement for certain medication expenses that are not covered directly. Check with your plan directly for more information about costs and coverage.
Alternatives to Weight Loss Medication
As mentioned, surgery may be an option for Medicare beneficiaries who need to lose weight in order to achieve health and preserve life, but this type of action often requires quite a bit of documentation for Medicare to consider coverage. This means that you may need to attempt to use medications like Qsymia prior to undergoing bariatric surgery for weight loss and overall health, even if this means that you will need to pay for Qsymia out-of-pocket.
Of course, diet and exercise changes can be made, but if you suffer from an eating disorder, simply making these changes is not easy and may not be effective in the long-term. This is why it’s a good idea to involve a team of medical experts to help you attain a healthy weight and set realistic standards against which you can measure your success. These experts may include your primary care physician, a nutritionist, a dietitian, a psychologist, a counselor or therapist and eating disorder support specialists.