Drugs that treat diabetes are hitting the market as obesity medications, and prescribers and insurers are now faced with vexing cost-benefit questions, observers say.

One of the latest of these repurposed drugs to be federally approved is Wegovy (semaglutide). It is also sold — at a lower dose — as diabetes drug Ozempic. Made by Novo Nordisk and delivered via injection, Wegovy has performed better than any other previous weight loss drug. Clinical trials participants lost 15% or more body weight over 68 weeks, the drugmaker reported.

But the price tag of these newer diabetes-turned-weight loss drugs can be high. Wegovy is expected to require lifetime use, with the evidence to date showing that it could cost $323,000 over 20 years at its current price, Kaiser Health News reported. 

“Since weight loss is known to reduce the risk of heart attack, high blood pressure and diabetes, might the new drug type be worth it?” the news outlet’s Julie Appleby asked.

Insurers are so far on the fence. The Medicare Part B program recently began encouraging doctors to see obesity as a significant health problem, according to the National Council on Aging. But Medicare and Medicaid consider weight loss or anti-obesity drugs lifestyle medications, and do not typically cover them. 

Meanwhile, the healthcare burden of overweight and obesity — alongside diabetes — in the long-term care population is expected to continue growing. “Overweight and obesity among the elderly will bring tremendous burden to LTC providers and Medicaid,” one study’s investigators concluded in 2014.

The Treat and Reduce Obesity Act, federal legislation that would address the coverage issue, has not moved forward since it was introduced in 2012, according to Kaiser’s Appleby. But the American Medical Association recognized obesity as a disease in 2013, which may help ease the path for insurance coverage, she added.

It’s been estimated that adding an obesity drug benefit to Medicare may result in reduction in Medicare spending overall when taking the resulting better health into account, although those estimates were based on much less expensive drugs, Appleby wrote.

But if the evidence for Wegovy holds up over time, “the clinical benefit and safety profile may justify payers reimbursing the product as a medically necessary treatment for the eligible obese population,” according to Forbes healthcare contributor Joshua Cohen. “And if reimbursed universally, this would induce more insured persons to take the product as their out-of-pocket costs would be much lower,” he concluded.

Older adults were included in clinical trials for Wegovy, including those aged 75 and older. But the numbers were small relative to the trial participant population, and “greater sensitivity of some older individuals cannot be ruled out,” noted independent medicine information website drugs.com.