Biden Administration Pushes for Wider Access to Weight Loss Medications for Millions on Medicare and Medicaid
The Biden administration has proposed a new rule that could significantly expand access to weight loss medications for millions of Americans. This rule aims to make drugs like Wegovy and Zepbound available to an additional 3.4 million Medicare users and 4 million Medicaid enrollees.
Currently, Medicare does not cover weight loss drugs unless they are used to treat conditions like diabetes or heart disease. Most states also do not cover these medications under Medicaid. However, the new rule would classify obesity drugs as treatments for a “chronic disease,” rather than just weight loss aids.
Chiquita Brooks-LaSure, the Administrator for the Centers for Medicare and Medicaid Services, emphasized that the medical community now recognizes obesity as a chronic disease. She described these medications as revolutionary in controlling weight.
The proposed change could drastically reduce the out-of-pocket costs for these drugs, which can currently exceed $1,000 per month. The federal government is expected to cover the majority of the costs, amounting to about $25 billion for Medicare and $11 billion for Medicaid over the next decade. States will need to contribute approximately $3.8 billion.
Officials do not anticipate that this will lead to an increase in out-of-pocket premiums. Dr. Meena Seshamani, Deputy Administrator of CMS, highlighted the Inflation Reduction Act’s role in reducing prescription costs for seniors and Medicare recipients, including a $2,000 out-of-pocket cap.
The proposal will undergo a 60-day public comment period before it can be finalized. The decision to implement it will ultimately rest with the incoming Trump administration. Larry Levitt from KFF noted that while Robert F. Kennedy Jr. has expressed skepticism about these drugs, Mehmet Oz, Trump’s pick to head CMS, has praised them. The final decision is likely to be made by the White House, which may be cautious about blocking a popular coverage expansion among seniors.
