Biden Administration Proposes Expanding Coverage for Anti-Obesity Drugs Under Medicare and Medicaid
In a significant move to make life-saving medications more accessible, President Joe Biden proposed expanding coverage for anti-obesity drugs under Medicare and Medicaid. Announced on November 26, the proposal would significantly reduce out-of-pocket costs for millions of Americans, potentially lowering expenses by as much as 95%.
The initiative targets newer weight loss medications such as Mounjaro, Ozempic, and Wegovy, which have been proven to prevent type 2 diabetes and reduce the risk of heart attacks and death by up to 20%. However, these medications can cost as much as $1,000 per month without insurance, making them unaffordable for many. By including them in Medicare and Medicaid coverage, the administration hopes to increase accessibility for those most vulnerable to obesity-related health issues.
Currently, Medicare and Medicaid cover drugs like Mounjaro, Ozempic, and Wegovy for conditions such as diabetes, but not for obesity as a standalone condition. Under the new proposal, expected to be effective starting in 2026, Medicare would cover these drugs for obesity, expanding access to an estimated 3.4 million Americans. The initiative would also ensure coverage for approximately 4 million adult Medicaid enrollees. The coverage expansion could reduce out-of-pocket costs by as much as 95% for some individuals.
The proposal comes with an estimated price tag of $25 billion for Medicare and $11 billion for Medicaid over the next decade, with states contributing around $4 billion for Medicaid. This move aims to ease the financial burden on patients and the healthcare system, particularly as demand for anti-obesity drugs has led to supply shortages, with some patients turning to unregulated online sources for cheaper alternatives.
Biden’s administration has made lowering healthcare and prescription drug costs a central goal, having previously capped the price of insulin at $35 for Medicare recipients and introduced a $2,000 cap on out-of-pocket drug costs for seniors. The proposal aligns with the broader goals of the Inflation Reduction Act, which empowers Medicare to negotiate drug prices, with the first cuts to take effect in 2026.
While the proposal is widely supported by healthcare advocates, it faces potential hurdles, including opposition from President-elect Donald Trump’s incoming administration. Robert F. Kennedy Jr., Trump’s pick to lead the Department of Health and Human Services, has expressed skepticism about relying on medication to combat obesity, advocating instead for healthier eating. The proposal could also face challenges from the drug industry and legal hurdles, as healthcare groups have already filed lawsuits to block similar cost-cutting measures, arguing they grant excessive power to federal regulators.
As the proposal moves forward, it represents a significant step in addressing the obesity crisis in the U.S., which has become a major public health issue. If implemented, it could improve the health and quality of life for millions of Americans while potentially reducing the long-term costs associated with obesity-related diseases.
Source: Wall Street Journal