Earlier this month, the Centers for Medicare and Medicaid Services (CMS) launched a pilot project that would allow those of us covered by Medicare Part D to climb on the GLP-1 bandwagon for the bargain rate of $50 a month. There are eligibility requirements, of course — BMI-defined obesity or chronic conditions such as hypertension and prediabetes — but the vast majority of U.S. seniors should have no trouble gaining access to the popular weight-loss drugs.
CMS officials describe the project, which is scheduled to expire at the end of next year, as an opportunity to gauge the demand for these drugs among the Medicare set while perhaps also preparing private Part D insurers for the tsunami to come. (The agency, which has not compelled insurers to participate in the pilot, is handling all the administration, including prior authorizations, claims adjudication, and pharmacy payments.)
It’s too early to know the extent to which seniors will be lured by the weight-loss promises of Zepbound and Wegovy and their ilk, but I expect there will be plenty of takers — especially considering mounting evidence that these drugs may do more than just help you shed some pounds.
By virtue of their apparent anti-inflammatory and metabolic powers, GLP-1s have been shown in various studies to be a possible antidote to everything from cardiovascular disease and osteoarthritis to obstructive sleep apnea and peripheral artery disease. And ongoing trials are pointing to its salutary effect on substance use disorders, psychiatric issues, and neurodegenerative conditions. Indeed, there’s even some evidence to suggest that they may help extend our lifespan.
Michael Corley, PhD, and his research team at the University of California, San Diego (UCSD), last month released the results of a study suggesting that one popular GLP-1 drug, semaglutide (marketed under the brand names Ozempic and Wegovy), may slow the aging process. Though not conclusive, their findings will no doubt inspire a good deal of hope among seniors — and not a little hype among leaders of our booming longevity industry.
The study, published in Nature Communications, involved 108 adults diagnosed with a form of HIV characterized by an accumulation of excess abdominal fat and an accelerated aging process. About half of the participants were treated with a weekly injection of semaglutide, while the others were given placebo injections. During the 32-week trial, researchers tracked biological changes in all the participants using a set of epigenetic clocks that measured various signs of aging at the cellular level.
“Many of the biological processes we study in HIV are also central to aging in the general population,” Corley, an associate professor at the UCSD School of Medicine, notes. “Because these processes can emerge earlier or be more pronounced in people with HIV, this community can help us identify interventions that may improve healthspan more broadly.”
You could call the results intriguing: Based on epigenetic clocks measuring DNA methylation in the blood, brain, heart, kidney, and liver — as well as overall inflammation and metabolic function — participants receiving the semaglutide displayed slower biological aging than the control group. The findings reinforced earlier research Corley and his team had published in npj Aging, which showed a slowing of biological aging among nearly half of study participants who had been diagnosed with HIV and fatty liver disease.
“We are not saying that semaglutide reverses aging or makes people younger,” Corley explains. “What we are seeing is a signal that it may slow some of the biological processes associated with aging. With newer GLP-1–based therapies now emerging, the field has an opportunity to test whether different drugs in this class have distinct effects on aging biology and to identify which patients may benefit most.”
While we await larger trials — and the accompanying hoopla — it may be prudent for seniors to tread carefully amid the hope and the hype. As Dani Blum reports in The New York Times, GLP-1s present a level of risk that is unique to older adults.
“If we put them on this medication that’s going to make them less hungry, less likely to eat, really significantly, potentially, reducing their protein intake — we’re setting them up for failure.” —Kathryn Nicole Starr, PhD
Rapid weight loss can rob seniors of muscle and reduce their bone density, both of which can limit mobility and increase the chance of frailty, falls, and fractures. The drugs, which tend to reduce thirst as well as appetite, may also raise an already high risk of dehydration — and accompanying kidney dysfunction — among seniors. And a depressed appetite could easily lead to a reduced consumption of protein, which is essential for maintaining muscle mass, notes Kathryn Nicole Starr, PhD, a Duke University associate professor of medicine, geriatrics, and palliative care.
“If we put them on this medication that’s going to make them less hungry, less likely to eat, really significantly, potentially, reducing their protein intake — we’re setting them up for failure,” she tells the Times.
Or at least for some unwanted complications. GLP-1s can affect the body’s ability to process some of the many medications seniors rely upon; and rapid weight loss can require lowering the dosage of common drugs, such as thyroid-hormone replacement meds, to prevent harmful side effects.
And there’s no way of knowing at this point whether the pilot project — and the bargain drug rate — will extend beyond the end of next year. If it doesn’t, seniors who have climbed on the GLP-1 bandwagon may find themselves losing access, regaining the weight they had lost, and contending with the consequences of muscle loss and other byproducts of the drugs.
Big Pharma ads like to encourage folks to “ask their doctor” if a particular drug is “right” for them. In the case of GLP-1s, I suspect even the most zealous longevity boosters among physicians may, at this point at least, lean toward a more conservative approach for their older patients.
Thomas Blackwell, MD, for instance, is leading a clinical trial on GLP-1s and longevity at the University of Texas Medical Branch and has also been taking Zepbound himself for the past year in hopes of slowing his own aging process. Still, he’s not what you would call sanguine about his decision.
“Do I know that that’s the right thing? I do not,” he tells the Times. “Do I recommend that for my patients? I do not.”
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