Millions more senior citizens and lower-income Americans could obtain coverage for costly anti-obesity drugs under a proposal being unveiled Tuesday by the Biden administration.
Some 3.4 million Medicare beneficiaries and about 4 million Medicaid recipients would gain access to these medications, which can cost as much as $1,000 a month for the uninsured, the White House said in a fact sheet. Some Medicare enrollees could see their out-of-pocket costs drop by as much as 95%.
“This proposal would allow Americans and their doctors to determine the best path forward so they can lead healthier lives, without worrying about their ability to cover these drugs out-of-pocket, and ultimately reduce health care costs to our nation,” the administration said.
The White House announcement lacked many details about the proposed rule, including which drugs are included, who would qualify and how much it would cost. It’s also unclear whether the proposal can be finalized before President Joe Biden leaves office in January.
The incoming Trump administration may not view expanding coverage of anti-obesity drugs as favorably. Robert F. Kennedy Jr., whom President-elect Donald Trump has picked to lead the Department of Health and Human Services, is not a fan. RFK Jr. expressed his disapproval of the medications in a Fox News appearance last month, saying a better and less expensive way to address obesity would be providing good food to Americans.
However, Dr. Mehmet Oz, whom Trump tapped to head the Centers for Medicare and Medicaid Services, has touted anti-obesity drugs on his talk show and on social media.
The Trump transition team did not immediately respond to a request for comment.
Limited access
The high cost of anti-obesity drugs, including the GLP-1 medicines Wegovy and Zepbound, has limited Americans’ access to the medications. The list price for Wegovy, for instance, is about $1,350 for a four-week supply.
Medicare is prohibited by law from covering drugs for obesity. But the Centers for Medicare and Medicaid Services opened the door to coverage of Wegovy for Medicare enrollees in March after the US Food and Drug Administration approved the drug for adults with cardiovascular disease who are either obese or overweight. Several insurers that provide Medicare Part D drug plans have since said they would cover the medication.
About 3.6 million Medicare enrollees with cardiovascular disease could be newly eligible for Wegovy, according to a KFF analysis released in April. That’s about a quarter of Medicare enrollees with obesity or overweight. (About 1.9 million of those in this group also had diabetes and may have already been eligible for Medicare coverage of other GLP-1 medications for diabetes, such as Ozempic.)
The coverage expansion could wind up costing Medicare nearly $3 billion a year and contribute to higher Part D premiums for all beneficiaries, the KFF analysis found.
Fully expanding GLP-1 coverage to Medicare enrollees with obesity or overweight would cost $35 billion over nine years, while the savings from their improved health would be small, according to a recent report from the Congressional Budget Office.
Meanwhile, only 13 states cover GLP-1 medications for obesity treatment, according to KFF. Half of states that don’t currently cover the drugs said they were considering adding it, but many were concerned about the cost.
Not all job-based health insurance plans cover anti-obesity medications, though larger employers are more likely to offer the benefit. Some 18% of firms in KFF’s annual Employer Health Benefits Survey, which includes those with 200 or more employees, cover GLP-1 drugs primarily for weight loss. About a quarter said they are very or somewhat likely to start coverage in the next year.
This story has been updated with additional developments.