WASHINGTON (AP) — Millions of Americans with obesity would become eligible for Medicare or Medicaid coverage of popular weight-loss medications like Wegovy and Ozempic under a new rule announced on Tuesday by the Biden administration.
The costly proposal from the Department of Health and Human Services sets the stage for a potential clash between the powerful pharmaceutical industry and Robert F. Kennedy Jr., a vocal opponent of weight-loss drugs who, as the president-elect Donald Trump’s nominee to lead the agency, could block the measure.
While the rule would grant access to millions of people for weekly injectable medications that have helped people lose weight so quickly that some have labeled them miracle drugs, the price tag would cost taxpayers up to $35 billion over the next decade.
“It’s a good day for anyone who suffers from obesity,” Health Secretary Xavier Becerra told The Associated Press in an interview. “It’s a radical shift for Americans who otherwise wouldn’t be able to afford these medications.”
The rule is expected to be finalized by January, days after Trump takes office. A bipartisan coalition of lawmakers has urged that Medicare cover the medications, arguing it could save the government billions of dollars in treating chronic diseases caused by obesity. Although Trump’s own position on weight-loss drug coverage isn’t clear, his allies and cabinet nominees who have promised to cut government spending could oppose the initial price tag.
Under the proposal, eligibility would be limited to those considered obese — someone with a body mass index of 30 or higher — for coverage. Some people already have coverage through Medicare or Medicaid if they have diabetes or are at risk of a stroke or heart disease.
Becerra estimated that 3.5 million additional people in Medicare and 4 million in Medicaid could qualify for the coverage. But research suggests many more could qualify: the Centers for Medicare and Medicaid Services projects that roughly 28 million people enrolled in Medicaid are obese.
Medicare, a government-backed insurance program, does not currently cover weight-loss products. However, the Biden administration’s proposed rule would recognize obesity as a disease that can be treated with medications.
The market for obesity medications has expanded significantly in recent years, with the Food and Drug Administration approving a new class of weekly injectables such as Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound to treat obesity.
People can lose about 15% to 25% of their body weight with these drugs, which mimic the hormones that regulate appetite by signaling fullness between the gut and the brain when people eat.
The cost of the medications has largely limited access to the wealthy, including celebrities who boast about their benefits. A monthly supply of Wegovy runs about $1,300 and Zepbound about $1,000. Shortages have also limited supply.
Kennedy, who as Trump’s nominee for secretary of Health and Human Services is subject to Senate confirmation, has criticized the drugs’ popularity. In speeches and on social media, he has argued that the United States should not cover the medications through Medicaid or Medicare. Instead, he supports a broad expansion of coverage for healthier foods and gym memberships.
“For half the price of Ozempic, we could buy organic foods grown regeneratively for every American, three meals a day and a gym membership for every obese American,” Kennedy told a group of federal lawmakers during a roundtable earlier this year.
