The Biden administration’s new proposal to cover expensive obesity treatments under Medicare and Medicaid could be a game changer for millions, but it also raises significant economic and procedural questions.
At a Glance
- The administration plans to include anti-obesity medications within Medicare and Medicaid coverage.
- This proposal is projected to cost $25 billion for Medicare and $11 billion for Medicaid over ten years.
- 7.4 million Americans could benefit from this proposal, but concerns about Medicare premiums exist.
- There is a 60-day public comment period before the rule can be finalized.
Expanding Coverage to Tackle Obesity
The Biden administration proposes to reinterpret federal law to permit Medicare and Medicaid to cover anti-obesity medications. This policy could significantly benefit the 7.4 million Americans who are currently paying out-of-pocket expenses for such medications like Ozempic and Wegovy. This is amidst a growing obesity crisis affecting over 40% of the U.S. adult population. Such coverage would recognize obesity as a chronic disease, allowing costly drugs to be employed under healthcare plans.
The Centers for Medicare and Medicaid Services (CMS) estimated that this new inclusion would lead to federal spending of $25 billion on Medicare and an additional $11 billion on Medicaid over the next decade. The bill, however, is partially checked by the potential benefit of improved public health outcomes, although the Congressional Budget Office (CBO) expresses minor savings.
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
Economic Implications and Comment Period
While enhancing access to anti-obesity medications for Medicare and Medicaid beneficiaries might provide financial relief, there are concerns about increasing Medicare premiums if drug prices remain unchecked. Democrat Senator Bernie Sanders, a longstanding critic of high drug prices, has actively highlighted these concerns.
“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
The administration anticipates public feedback, allowing a 60-day period for comments. Future governance could also influence the trajectory of this initiative, considering the potential changes stemming from new political leadership in Washington.
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
Addressing Racial Disparities
Racial disparities in obesity treatment remain evident, with 85% of drugs like semaglutide currently prescribed to a Caucasian demographic. This proposal aims to extend the coverage, aspiring to bridge the gap and provide equitable access to vital medications across different ethnic groups. Experts believe that while the costs are high, having Medicare and Medicaid cover these medications could help diminish these disparities and improve access for at-risk communities.
It’s clear the administration considers this a necessary strategy against a condition labeled as a chronic disease, but it anticipates chorus calls for implementing a balanced approach concerning drug cost and corresponding state capacities.
Sources:
Biden administration unveils plan to cover weight loss meds under Medicare, Medicaid
Biden proposes weight loss drug coverage for people on Medicare and Medicaid
Biden Administration Proposes Coverage for Weight Loss Medications in Medicare and Medicaid
