The Trump administration on Friday rejected a Biden plan that would require Medicare and Medicaid to cover obesity drugs and expand opportunities for millions of people.
Under the laws that established Medicare's D Part fund Fuce, the program is prohibited from paying for drugs for “weight loss”. But the Biden administration's proposal last November tried to evade the ban by arguing that it allowed drugs to treat obesity and its associated diseases.
Expanding drug coverage will cost the federal government billions of dollars. The Congressional Budget Office estimates that federal costs will be about $35 billion in 10 years.
The decision announced Friday is part of a larger 438-page statute that updates some of Medicare's pharmaceutical benefits and part of Medicare Advantage, a private insurance plan for now used by half of Medicare beneficiaries.
Catherine Howden, spokesman for the Medicare and Medicaid Services Center, said in an email that the agency believes it is “not appropriate at the moment.” But she said the agency has not ruled out coverage and “consider future policy options” for drugs.
Medicare is a government insurance program for Americans over 65 years of age, as well as people with disabilities, and does cover weight loss medications for people with diabetes, as well as those with obesity and smaller populations with heart disease or sleep apnea.
Biden plans to expand coverage to patients who are obese but do not have these diseases. Medicare officials estimate that under the policy, about 3.4 million people choose to take the drugs.
The most popular weight loss pill is made by Novo Nordisk, which sells its drugs for Ozempic and Eli Lilly of obesity and diabetes, which sells its products for Mounjaro of obesity and diabetes.
Eli Lilly and Novo Nordisk now offer their products for $350 to $500 for their own money and pay for their own money instead of being insured. But until recently, patients sometimes paid more than $1,300 a month.
Secretary of Health Robert F. Kennedy Jr.
These drugs have been shown in clinical trials that benefit far exceeding weight loss, such as preventing heart attacks and strokes.
Supporters of the expansion of coverage believe that government spending on drugs will be paid at least in part in the long run. They say patients will become healthier, which will prevent expensive medical expenses. It is not clear whether this savings will be achieved.
State Medicaid programs that provide health care for the poor currently have the option to cover medications, and some do so. If the final Biden policy is completed, every state will need coverage.
Obesity medication costs hundreds of dollars per month for Medicare and Medicaid, although the exact price is secret.
Many employers and private health insurance plans do not include drugs. Some of these, including state employee benefits programs in North Carolina and West Virginia, dropped drugs at high costs after their popularity dropped rapidly.
Without insurance coverage, many patients about Medicare and Medicaid have been relying on cheap imitation versions of drugs produced through a drug mixing process called compounding. These versions are allowed under $200 a month because of insufficient supply of branded drugs. But regulators have ordered sales to end as soon as possible as supply of branded products improves.
Republicans in Congress expressed interest in asking Medicare to cover the drugs. The idea is included in a list of policy choices developed by the House Budget Committee earlier this year. But that doesn't seem to be the main priority right now.
To reduce costs, Medicare chose Novo Nordisk's Wegovy for negotiations to lower prices under laws passed by democratically controlled Congress in 2022. These lower prices will begin in 2027 for those eligible, and this change has the potential to limit the long-term cost of coverage.
