Biden-Harris Administration Proposes Expansion to Medicare and Medicaid to Include Weight Loss Medications
The proposal aims to reduce out-of-pocket costs for a number of weight loss medications by 95%.
Image Credit: Adobe Stock Images/Anchalee
The Biden-Harris Administration announced a proposed rule aimed at expanding Medicare and Medicaid coverage for anti-obesity medications (AOMs), including Ozempic and Wegovy, from Novo Nordisk, and Mounjaro and Zepbound, from Eli Lilly. According to the administration, this initiative aligns with the Administration's National Strategy on Hunger, Nutrition, and Health, which integrates nutrition, counseling, and comprehensive care for obesity.1,2
Currently, Medicare is prohibited from paying for weigh loss drugs, outside of treating conditions such as diabetes or to combat an increased risk of heart disease. Despite states having the option to cover obesity drugs under Medicaid, a vast majority do not under current laws.2 The new proposal would require all states to cover the medicines moving forward.3
"The medical community today agrees that obesity is a chronic disease," said Chiquita Brooks-LaSure, administrator, Centers for Medicare and Medicaid Services, in a call with reporters. “These drugs are the beginning of a revolution in the way that weight is controlled."
According to the White House, the current cost for a month’s supply of a weight loss drug can potentially cost $1,000 or more. Under the new proposal, the federal government would pick up most of the costs, including $25 billion for Medicare and $11 billion for Medicaid over 10 years. States will have to pay approximately $3.8 billion. As a result, the administration doesn’t expect an increase in out-of-pocket premiums.2
“"The Inflation Reduction Act has made historic strides in reducing the cost of prescriptions for our nation's seniors and those on Medicare, including a $2,000 out-of-pocket cap and the IRA premium stabilization policies,” said Meena Seshamani, CMS deputy administrator, on the same call.2,3
According to the New York Times, CMS estimates that around 3.4 million additional patients in Medicare would become eligible for obesity drugs, and around four million patients in Medicaid would gain coverage, costing the programs billions of dollars if the proposal is approved.3
Data from the Centers for Medicare & Medicaid Services (CMS) show that there are currently over 67 million people currently enrolled in Medicare, 50.5% of which are also enrolled in other healthcare plans. Further, 89.4% of those enrolled are 65 or older and 80.4% also have Medicare Part D coverage.4
Current statistics suggest that 42% of people in the United States are living with obesity. AOMs have been found to prevent Type 2 diabetes and reduce cardiovascular risks by up to 20%.1 According to the Centers for Disease Control and Prevention, the prevalence of severe obesity in adults was 9.4% in 2023 in the United States, with women demonstrating higher rates in each group compared to men. In adults between 40 and 49 years of age, the prevalence was 46.4%. Additionally, the prevalence was 35.5% in adults between 20 and 39 years of age and 38.9% in adults over 60 years of age.5
The implementation of such a proposal will depend on the views of the incoming Trump administration, which includes a number of appointments who have made their desires to cut federal spending known. Despite the potential pushback, demand for the medications remain high, with a recent survey finding that 61% of all Americans supporting Medicare coverage for AOMs amid Medicare beneficiaries paying full prices.3
References
1. FACT SHEET: Biden-Harris Administration Takes Latest Step to Lower Prescription Drug Costs by Proposing Expanded Coverage of Anti-Obesity Medications for Americans with Medicare and Medicaid. White House. November 26, 2024. Accessed November 26, 2024. https://www.whitehouse.gov/briefing-room/statements-releases/2024/11/26/fact-sheet-biden-harris-administration-takes-latest-step-to-lower-prescription-drug-costs-by-proposing-expanded-coverage-of-anti-obesity-medications-for-americans-with-medicare-and-medicaid/
2. Biden proposes weight loss drug coverage for people on Medicare and Medicaid. NBC. November 26, 2024. Accessed November 26, 2024. https://www.nbcnews.com/health/health-news/biden-proposes-requiring-medicare-medicaid-cover-weight-loss-drugs-rcna181756
3. Obesity Drugs Would Be Covered by Medicare and Medicaid Under Biden Proposal. NY Times. November 26, 2024. Accessed November 26, 2024. https://www.nytimes.com/2024/11/26/upshot/obesity-drugs-medicare-medicaid.html
4. Medicare Monthly Enrollment. CMS. Accessed November 26, 2024. https://data.cms.gov/summary-statistics-on-beneficiary-enrollment/medicare-and-medicaid-reports/medicare-monthly-enrollment
5. Obesity and Severe Obesity Prevalence in Adults: United States, August 2021–August 2023. CDC. Accessed November 26, 2024. https://www.cdc.gov/nchs/products/databriefs/db508.htm
