Biden Proposes Medicare and Medicaid Cover Weight Loss Drugs
New Rule Would Dramatically Expand Access to Anti-Obesity Medications
The Biden administration plans to require Medicare and Medicaid to offer coverage of weight loss medications for patients seeking to treat obesity. The new rule, proposed on Tuesday, would significantly expand access to anti-obesity medications like Wegovy, Ozempic, and Mounjaro.
Current Coverage Limitations
Until now, Medicare and Medicaid have only provided insurance coverage for these drugs when used to treat conditions like diabetes. This has resulted in out-of-pocket costs for patients, with a month’s supply of weight loss drugs costing $1,000 or more, according to a White House official.
Obesity Epidemic
More than 40% of Americans are considered obese, putting them at risk for heart disease, diabetes, breathing problems, stroke, and some cancers, according to the Centers for Disease Control and Prevention (CDC).
Expanding Access
The new rule would expand access to the drugs for 3.4 million Americans who use Medicare and another 4 million people enrolled in Medicaid, the White House official said. This would bring the total number of people with access to these medications to nearly 8 million.
Racial Disparities in Access
Research suggests there are significant disparities in who receives weight loss drugs. A health care analytics company, PurpleLab, found that in 2023, about 85% of semaglutide prescriptions were dispensed to white people. When insurance doesn’t cover the drug, its high cost becomes a barrier for many low- and middle-income Americans, doctors have said.
Expanding Coverage to Reduce Disparities
Expanding coverage to patients who rely on Medicare and Medicaid could reduce some of these disparities. Dr. Laure DeMattia, a bariatric medicine specialist, noted that “Our Medicare and Medicaid populations are some of the most at-risk and they do not have access to any anti-obesity medication.”
The Issue in the Workplace
The issue is also becoming a workplace matter, as the drugs’ popularity increases and employers balance program costs and their workers’ needs. Survey results published in Health Affairs found that less than a fifth of large companies in the U.S. offered health insurance plans that covered weight loss drugs.
How the Drugs Work
Weight loss drugs like Wegovy are injectable medications that mimic a hormone called GLP-1, which helps control blood sugar, manage people’s metabolism, and help them feel full. The drugs are being studied for their long-term effects and potential uses in other conditions, such as reducing sleep apnea and cutting back on alcohol.
Conclusion
The Biden administration’s proposed rule aims to make weight loss medications more accessible to those who need them, reducing the financial burden and expanding access to a critical treatment option for millions of Americans.
FAQs
* What is the proposed rule?
The proposed rule would require Medicare and Medicaid to cover weight loss medications for patients seeking to treat obesity.
* How many people would be impacted by the rule?
The rule would expand access to weight loss medications for 3.4 million Americans who use Medicare and 4 million people enrolled in Medicaid, a total of nearly 8 million people.
* What are the current coverage limitations?
Until now, Medicare and Medicaid have only provided insurance coverage for these drugs when used to treat conditions like diabetes.
* What are the potential benefits of the proposed rule?
The rule could reduce disparities in access to weight loss medications and make the treatment more affordable for many Americans.
