Millions May Gain Access to Obesity Drugs Under Biden Medicare Plan

livewell
November 28, 2024
Noah Bennett

Intro

The Biden administration has proposed the inclusion of obesity drugs for those under coverage of Medicare and Medicaid. This can reduce monetary expenses for over 7 million obese beneficiaries (4 million related to Medicaid and 3 million Medicare beneficiaries) who take or need these medicines. The White House said in a fact sheet that the average cost of these drugs is $1000 per month, and this new proposed rule can reduce up to 95% of out-of-pocket costs for beneficiaries.

Medicare and Obesity

The rules prevent Medicare and Medicaid coverage for weight loss medicines because they are not considered medically necessary. However, CMS (the Centers for Medicare and Medicaid Services), a federal agency that administers Medicare and Medicaid, is now considering interpreting these rules for Medicare weight loss drugs due to new findings about the severity of obesity on the health of the patient.

An administrator of the federal agency told reporters that the medical community thinks differently about obesity, which is now considered a chronic condition due to its negative impact on critical health issues, such as diabetes, heart diseases, and stroke, that increases the risks of premature death. Nearly 40% of Americans are obese, while around 22% of Medicare members are also suffering from this condition. The percentage of obese Medicare enrollees has doubled in nearly a decade, which signifies an alarming trend.

Role of the New Administration

The current situation shows that the cost of obesity drugs could reach $25 billion over a decade, ultimately costing $11 billion to the federal government and nearly $4 billion to states during this period. The extended program, expected to start in 2026, would not include overweight persons but is limited to people with obesity. However, this can only be finalized after the departure of the current president, Joe Biden, from his office.

Therefore, it is not clear whether it can even start in the future because the new administration can bulldoze the whole plan. It is evident from a recent statement of RFK Junior, the nominee of the president-elect for the Department of Health and Human Services. He disapproved of such a move by stating that a more effective and less expensive way to treat obesity is by providing healthy food to Americans.

However, there is a glimpse of hope due to some encouraging statements from Dr. Mehmet Oz, the new possible head of the CMS. Dr. Oz favored Ozempic Medicare coverage for assisting those who want to lose their weight through anti-obesity medications.

Cost of Obesity Drugs

Most Americans can’t afford anti-obesity drugs due to their higher costs. For instance, the price of Wegovy (a GLP-1 medicine) is $1,350 for four weeks. Currently, Wegovy Medicare coverage is only available for patients with chronic conditions, such as cardiovascular diseases or diabetes. The recent proposed expansion of weight loss drugs covered by Medicare for all obese and overweight persons will put a burden of $35 billion in nine years. So far, only 13 states and some large employers (with 200 or more employees) offer coverage of GLP-1 medications for weight loss. However, some other states and employers are now considering including coverage of anti-obesity drugs in their insurance plans after this recent step by the federal government.