The Biden administration proposes a groundbreaking expansion of Medicare and Medicaid benefits to include coverage for obesity medications.
At a Glance
- Reinterpretation of federal law is to cover anti-obesity medications under Medicare and Medicaid.
- The estimated costs are these of $25 billion for Medicare and $11 billion for Medicaid over the next decade.
- There are potential benefits for 7.4 million Americans with obesity.
- The public comment period may be influenced by incoming policy directions.
Redefining Federal Law
The Biden administration is reinterpreting federal law to allow Medicare and Medicaid patients access to anti-obesity medications. These drugs, including Ozempic and Wegovy, have not been subsidized under the current healthcare framework. The changes aim to alleviate the financial burden on approximately 7.4 million Americans. The administration classifies obesity as a chronic disease, ensuring medications for it receive similar insurance coverage as other chronic conditions like diabetes.
Including anti-obesity drugs in Medicare and Medicaid arrives alongside the recognition of obesity as a chronic illness affecting over 40% of adults nationwide. Concerns exist that these additions could drive up Medicare premiums if drug costs don’t decrease. The plan is open for a public commentary phase, which may shape its future under successive government directives.
Millions of Americans with obesity would be eligible to have weight-loss drugs like Wegovy and Ozempic covered by Medicare and Medicaid under a new rule proposed by the Biden administration. CBS News' chief medical correspondent @DrLaPook explains how the proposal works. pic.twitter.com/qNDrBK0KFc
— CBS Evening News (@CBSEveningNews) November 27, 2024
Financial Ramifications
The Centers for Medicare and Medicaid Services projects the proposed rule will incur significant costs: $25 billion for Medicare and $11 billion in Medicaid spending over ten years. The Congressional Budget Office estimates federal costs could climb to $35 billion between 2026 and 2034. This rule revises the Medicare Part D program’s exclusion of weight loss drugs, planning to expand access to critical medications.
“People with obesity deserve to have affordable access to medical treatment and support, including anti-obesity medications for this disease; just as a person with type two diabetes can access these medications to get healthy,” CMS Administrator Chiquita Brooks-LaSure has said.
Supported by the recognition of obesity as a chronic disease, the administration stresses that early treatment through medication could reduce the prevalence of serious health conditions like heart disease and diabetes. This approach seeks to juxtapose initial high drug costs with potential long-term savings in overall healthcare expenses.
President Biden has proposed that weight loss drugs like Wegovy and Ozempic be covered for those on Medicare or Medicaid who are considered obese.
Currently, Medicare and Medicaid exclude weight loss treatments and medications from coverage, creating a major healthcare… pic.twitter.com/AePvgPzk0I
— NowThis Impact (@nowthisimpact) November 27, 2024
Broader Impact and Considerations
Encouragement from CMS towards states for feedback highlights the importance of local implementation insights, especially with Medicaid provisions varying across territories. Presently, only nine states cover the drug Wegovy, showing room for expansion.
“The medical community today agrees that obesity is a chronic disease. It is a serious condition that increases the risk of premature death and can lead to other serious health issues, such as heart disease, stroke, and diabetes,” Brooks-LaSure says.
The initiative’s fiscal impact faces scrutiny as policymakers deliberate on whether such healthcare expansion could indeed bridge coverage gaps and lessen out-of-pocket expenses exceeding $1,000 monthly. Public comments over the next 60 days could significantly shape the proposal’s development into actionable policy.
