TUESDAY, Nov. 26, 2024 (HealthDay News) -- The outgoing Biden administration will propose that pricey GLP-1 obesity medications such as semaglutide (Wegovy), and tirzepatide (Zepbound) be covered by Medicare and Medicaid.
However, the move would have to be approved by the new Trump administration.
Right now, a law passed by Congress two decades ago prevents the Medicare and Medicaid from covering any "weight loss" drug.
Under the Biden proposal, that rule would be circumvented by calling the medications treatments for the disease of obesity and its related health issues.
“We don’t want to see people having to wait until they have these additional diseases before they get treatment,” Chiquita Brooks-LaSure, the administrator of the Centers for Medicare and Medicaid Services (CMS), told The New York Times.
Under the proposed rule, every state Medicaid program would be required to cover the cost of the medications, which currently are priced at more than $1,200 per month before any drug company discounts.
According to CMS estimates, passage of the rule would open access to the weight-loss medications to 3.4 million potential new patients under Medicare and another 4 million under Medicaid.
But the incoming Trump administration would need to sign off on the new legislation. The person tapped by the president-elect to head the Department of Health and Human Services, Robert F. Kennedy, Jr, has long been a skeptic of the drugs, asserting that weight loss should instead be tackled by healthy eating.
“If we just gave good food, three meals a day, to every man, woman and child in our country, we could solve the obesity and diabetes epidemic overnight,” Kennedy told Fox News before the election.
That opinion runs counter to Dr. Mehmet Oz, the former television host who is Trump's pick to head the CMS.
Oz, who would report to Kennedy, has been vocal in his support of GLP-1 medications, the Times noted.
The Biden administration's proposal puts pressure on Trump and his team, who on their own may not have made such a move.
However, public support for Medicare coverage of the blockbuster meds is strong: One poll from the University of Michigan found that 76% of older Americans support such a move.
GLP-1 medications work by mimicking the action of a hormone (GLP-1) in the small intestine. This slows stomach emptying and increases a person's feeling of fullness, helping them to eat less.
Evidence is mounting that the drugs are effective in helping users lose weight and reduce their odds for a host of health issues including diabetes, heart disease, kidney problems, fatty liver disease, arthritis, and even asthma.
However, allowing eligible patients coverage for the meds would cost Medicare $25 billion over a decade and Medicaid $11 billion, Brooks-LaSure told the Times.
It's probable that the cost of Wegovy (made by Novo Nordisk) and Zepbound (made by Eli Lilly) would fall: The Biden administration has already passed legislation allowing Medicare to negotiate the price of Wegovy, starting in 2025.
As well, many people who have obesity also have other chronic diseases -- such as diabetes or heart disease -- and Medicare and Medicaid already cover the drugs for people with these conditions. The number of people who have obesity without such conditions is relatively small.
However, any rule widening access to Wegovy and Zepbound via Medicare or Medicaid to anyone struggling with obesity would be ideal, Brooks-LaSure said.
“Everybody deserves access,” she told the Times. “The more friction there is in the system — the more hoops you have to meet, all these characteristics — the harder it is for people to get the care they need.”
More information
Find out more about GLP-1 medications at the Cleveland Clinic.
SOURCE: The New York Times
