President Joe Biden plans to require Medicare and Medicaid to offer coverage for weight-loss medications, a move that could cost $36 billion for the two federal programs over the next decade.
The new rule could significantly expand access to anti-obesity drugs such as Ozempic and Wegovy. Without insurance coverage, the drugs can cost as much as $1,000 a month.
Lawmakers previously prohibited Medicare from paying for weight loss drugs unless those drugs are used to treat diabetes or manage heart disease risks.
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The White House said an estimated 42% of the U.S. population has obesity, which is “a chronic disease, with increased risk of all-cause mortality and multiple related comorbidities such as diabetes, cardiovascular disease, stroke, some cancers, and more.”
The new proposal would expand access to medications for obesity. The White House said it would help an estimated 3.4 million Americans with Medicare and about 4 million adult Medicaid enrollees.
“This proposal would allow Americans and their doctors to determine the best path forward so they can lead healthier lives, without worrying about their ability to cover these drugs out-of-pocket, and ultimately reduce health care costs to our nation,” according to a White House statement.
Under Biden’s plan, the federal government would pick up most of the costs. That’s about $25 billion for Medicare and $11 billion for Medicaid over the next decade. States would be on the hook for another $3.8 billion.
The proposal requires a 60-day public comment period before it can go into effect, meaning it would be up to the incoming Trump administration to complete it.
Medicare provides federal health insurance for people 65 or older, and some people younger than 65 with certain disabilities or conditions. Medicaid is a joint federal and state program that helps cover medical costs for some low-income people.
U.S. Rep. Wiley Nickel, R-N.C., praised the move.
“Today’s announcement to expand Medicare & Medicaid coverage for anti-obesity medications is a big step forward,” he wrote on X. “I’ve been a strong advocate for this change because it will improve lives and lower health care costs.”
Others have warned about the cost, including U.S. Sen. Bernie Sanders, I-Vermont.
“The good news is that HHS recognizes that vitally important anti-obesity medicines like Wegovy and Zepbound should be made available to all Americans, regardless of income,” Sanders said in a statement. “The bad news is that unless Medicare demands that Novo Nordisk and Eli Lilly substantially reduce the prices for these anti-obesity drugs, Medicare premiums for all seniors would skyrocket.”
He said drug prices must come down.
“If this proposal is to be financially responsible for seniors and taxpayers, Medicare and Medicaid cannot pay up to 10-15 times more for these drugs than they cost in Europe and other major countries,” Sanders said. “We cannot allow Medicare and Medicaid to simply be a cash cow for Novo Nordisk and Eli Lilly.”
Syndicated with permission from The Center Square.