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WASHINGTON — President Joe Biden on Tuesday proposed expanding coverage of anti-obesity drugs for millions on Medicare and Medicaid, which could cut out-of-pocket expenses for some by as much as 95%.
This move would enable more Americans to afford new weight loss medications that can help prevent type 2 diabetes and lower the risk of death and heart attacks by up to 20%, but cost as much as $1,000 a month without insurance coverage.
The current rules for the Medicare and Medicaid government health insurance programs cover the use of drugs such as Mounjaro, Ozempic and Wegovy for certain conditions like diabetes, but not for obesity as a condition on its own.
A new proposed regulation, to be published by the Department of Health and Human Services on Tuesday, would require Medicare to cover these drugs as a treatment for obesity, expanding access for an estimated 3.4 million Americans with Medicare.
"Medicare coverage would reduce out-of-pocket costs for these prescription drugs by as much as 95 percent for some enrollees," the White House said in a statement.
This would also ensure access to the medications for approximately 4 million adult Medicaid enrollees, it said.
“Today’s proposed action is a major step forward in ensuring that adults with obesity get the same quality care and access to treatments as those with the 230 chronic conditions where obesity is a significant factor,” said Nancy Glick, National Consumers League Director of Food and Nutrition Policy. “Today, only 10 percent of people with obesity get help from medical professionals, meaning the disease remains largely undiagnosed and undertreated. If CMS’s proposed rule is implemented, it will go a long way towards closing this obesity treatment gap, especially since health insurance companies closely align coverage decisions with Medicare policy.”
The cost of new anti-obesity medicines is an obvious concern to organizations like NCL, the public health community, and policymakers. However, CMS’s proposed expansion of Medicare and Medicaid coverage for a new class of injectable GPL-1 (glucagon-like peptide-1 receptor) agonists that can achieve a substantial weight loss (up to 20 percent) represents an important investment in the improved health of Americans.
