Millions of obese Americans would be eligible for popular weight-loss drugs like Wegovy or Zepbound that are covered by Medicare or Medicaid under a new rule proposed by the Biden administration Tuesday morning.
The proposed proposal from the US Department of Health and Human Services immediately sets the stage for a showdown between the powerful pharmaceutical industry and Robert F. Kennedy Jr., an outspoken opponent of weight-loss drugs who, as President-elect Donald Trump’s nominee to lead the agency, could block the measure.
While this rule would give millions of people access to weekly injections that have helped people shed excess weight so quickly that some have called them miracle drugs, it will cost taxpayers up to $35 billion over the next decade.
“It’s a good day for anyone struggling with obesity,” US Health and Human Services Secretary Xavier Becerra said in an interview with The Associated Press. “It’s a game-changer for Americans who can’t otherwise afford these medications.”
The rule will not be finalized until January, days after Trump takes office. A bipartisan coalition of members of Congress has lobbied for Medicare to cover these drugs, saying that could save the government from spending billions of dollars on treating chronic diseases caused by obesity. While it’s unclear where Trump himself stands on weight-loss drug coverage, his allies and Cabinet picks who have pledged to cut government spending may balk at the advance price.
Under the proposal, only those considered obese — anyone with a body mass index of 30 or higher — would qualify for coverage. Some people may already get drug coverage through Medicare or Medicaid if they have diabetes or are at risk for stroke or heart disease.
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Becerra estimated that an additional 3.5 million people on Medicare and 4 million on Medicaid could qualify for drug coverage. But research suggests that many more people may qualify, with the Centers for Medicare and Medicaid Services estimating that nearly 28 million people on Medicaid are considered obese.
Medicare has been barred from offering the drugs under a decades-old law that prohibits the government-backed insurance program from covering weight-loss products. However, the rule proposed by the Biden administration recognizes obesity as a disease that can be treated with the help of medications.
The market for anti-obesity drugs has expanded dramatically in recent years, with the FDA approving a new class of weekly injections such as Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound for the treatment of obesity.
People can lose up to 15% to 25% of their body weight when taking the drugs, which mimic hormones that regulate appetite by communicating fullness between the intestines and the brain when people eat.
The cost of these drugs has made them largely limited to the wealthy, including celebrities who boast of their benefits. Wegovy’s monthly offer is $1,300, and Zepbound will save you $1,000. Medicine shortages have also limited supplies.
Kennedy, who is subject to Senate confirmation as Trump’s nominee for Health and Human Services secretary, criticized the popularity of the drugs. In speeches and on social media, he said the United States should not cover drugs through Medicaid or Medicare. Instead, he supports expanding coverage of healthy foods and gym memberships.
“For half the price of Ozempic, we can buy renewable organic food for every American, three meals a day and a gym membership, for every obese American,” Kennedy told a group of federal lawmakers during a roundtable earlier this year. Ozempic is a diabetes medication that can stimulate weight loss.
& Edition 2024 The Canadian Press
