Biden proposes new rule for weightloss drugs to be covered by Medicare, Medicaid
Nov 26, 2024
The Biden administration is proposing a new rule to significantly expand the coverage of weight-loss drugs for Americans on Medicare and Medicaid, the White House announced Tuesday.
The proposal could provide millions who struggle with obesity access to potentially life-saving medications like Ozempic and Wegovy, which can cost as much as $1,000 per month for people without insurance.
Obesity, which affects an estimated 42% of the U.S. population, is now widely recognized as a chronic disease associated with an increased risk of all-cause mortality. It can also be linked to many related comorbidities including diabetes, cardiovascular disease, stroke and some types of cancers, the White House said in a news release.
But despite major scientific advancements in the treatment of obesity over the past few years, millions of people are not able to access medication because of the cost.
The new rule, which is set to go into effect in 2026, would provide coverage for the so-called “miracle drugs” to an estimated 4 million people with Medicaid and roughly 3.4 million older adults in the Medicare program.
“It’s a good day for anyone who suffers from obesity,” said U.S. Health and Human Services Secretary Xavier Becerra. “It’s a game changer for Americans who can’t afford these drugs otherwise.”
Medicare and Medicaid currently cover some of these weekly injectables, which work by activating receptors of hormones secreted from the intestine to reduce appetite and food intake — but only for certain conditions like diabetes.
In November 2023, the U.S. Food and Drug Administration approved Eli Lilly’s diabetes drug Mounjaro to be sold under the name Zepbound as a weight-loss medication. Its approval came just over two years after the approval of weight-loss drug Wegovy, a higher-dose version of Novo Nordisk’s diabetes medication Ozempic.
While new rule could cost taxpayers as much as $35 billion over the next decade, according to an estimate by the Congressional Budget Office, it could reduce money spent in the long run.
“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,” the White House said.
The proposal will likely encounter fierce resistance from big pharma and Robert F. Kennedy Jr., Trump’s nominee to lead the Department of Health and Human Services. RFK Jr. has been an outspoken opponent of anti-obesity drugs, along with vaccines.
With News Wire Services