Biden Administration proposes Medicare, Medicaid coverage for weight-loss drugs

The Biden administration unveiled a proposal on Tuesday that could make popular weight-loss drugs like Wegovy and Ozempic accessible to millions of Americans through Medicare and Medicaid. The rule, introduced by the U.S. Department of Health and Human Services (HHS), seeks to classify obesity as a treatable disease, opening the door for coverage of costly medications that have been hailed as game-changers in combating obesity.

Expanded Access to Weight-Loss Drugs

Under the proposal, only individuals classified as obese—those with a body mass index (BMI) of 30 or higher—would qualify for coverage. Currently, some Medicare and Medicaid beneficiaries may access these drugs if they have conditions like diabetes or are at risk of stroke or heart disease. The new rule could extend coverage to an estimated 3.5 million people on Medicare and 4 million on Medicaid, according to HHS Secretary Xavier Becerra.

“It’s a good day for anyone who suffers from obesity,” Becerra told The Associated Press. “It’s a game changer for Americans who can’t afford these drugs otherwise.”

Potential Economic and Political Implications

The proposal is expected to ignite debate, particularly as the cost to taxpayers could reach $35 billion over the next decade. A bipartisan group of lawmakers has advocated for expanding coverage, arguing that treating obesity could reduce long-term government spending on chronic diseases linked to the condition.

However, President-elect Donald Trump’s nominee for HHS Secretary, Robert F. Kennedy Jr., has expressed opposition to the measure. Kennedy, who has frequently criticized the growing popularity of weight-loss drugs, has instead called for expanded access to healthy food and gym memberships as alternative solutions.

“For half the price of Ozempic, we could purchase regeneratively raised, organic food for every American, three meals a day, and a gym membership for every obese American,” Kennedy said during a recent roundtable discussion with lawmakers.

The Weight-Loss Drug Market

Drugs like Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound have gained traction in recent years as effective treatments for obesity, with some patients losing 15% to 25% of their body weight. These medications mimic appetite-regulating hormones that signal fullness to the brain.

Despite their effectiveness, the high cost of these drugs $1,300 per month for Wegovy and $1,000 for Zepbound has limited access primarily to affluent individuals, including celebrities who have publicly praised their benefits. Supply shortages have further restricted availability.

Historical Barriers to Coverage

Medicare has been prohibited from covering weight-loss products under a decades-old law. The proposed rule would overturn this restriction, aligning with recent advancements in anti-obesity treatments and recognizing obesity as a disease requiring medical intervention.

As the proposal moves forward, it could face significant hurdles, particularly if Kennedy uses his platform to oppose the measure. His confirmation as HHS Secretary is subject to Senate approval, adding another layer of uncertainty to the rule’s future.

The debate highlights the growing tension between addressing obesity through medical treatments versus broader public health initiatives. Whether the rule is enacted could have significant implications for the healthcare system, the pharmaceutical industry, and millions of Americans struggling with obesity.