WASHINGTON (AP) — Millions of obese Americans would be eligible for popular weight-loss drugs like Wegovy or Ozempic covered by Medicare or Medicaid, under a new rule the Biden administration proposed Tuesday morning.
The costly proposal from the U.S. Department of Health and Human Services sets the stage for a possible showdown between the powerful pharmaceutical industry and Robert F. Kennedy Jr., an outspoken opponent of weight-loss drugs who, as Donald Trump’s presidential candidate, to run the agency could try to block the measure.
While the rule would give millions of people access to weekly injectables that have helped people shed pounds so quickly that some are calling them miracle drugs, it would cost taxpayers as much as $35 billion over the next decade.
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“It’s a good day for anyone who is obese,” U.S. Health and Human Services Secretary Xavier Becerra told The Associated Press in an interview. “It’s a game changer for Americans who otherwise couldn’t afford these medications.”
A bipartisan coalition of members of Congress has lobbied to have the drugs covered by Medicare, saying it could save the government from spending billions of dollars on treating chronic conditions that stem from obesity. While it’s unclear where Trump himself stands on the messaging about the weight-loss drugs, his allies and Cabinet members who have vowed to cut government spending could be hesitant about the upfront price tag.
Under the proposal, only those considered obese — someone with a body mass index of 30 or higher — would be eligible for coverage. Some people may already get drug coverage through Medicare or Medicaid if they have diabetes or are at risk for stroke or heart disease.
Becerra estimated that another 3.5 million people on Medicare and 4 million people on Medicaid could qualify for coverage of the drugs. But research suggests many more people could qualify, with the Centers for Medicare and Medicaid Services estimating that about 28 million people on Medicaid are considered obese.
Medicare is barred from offering the drugs under a decades-old law that bars the government-backed insurance program from covering weight-loss products. However, the Biden administration’s proposed rule would recognize obesity as a disease that can be treated with the help of the drugs.
The market for obesity drugs 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 as much as 15% to 25% of their body weight from the drugs, which imitate the hormones that regulate appetite by communicating fullness between the intestines and the brain when people eat.
The cost of the drugs has largely limited them to the wealthy, including celebrities who brag about their benefits. A monthly supply of Wegovy is $1,300 and Zepbound will run you $1,000. Medicine shortages have also limited supplies.
Kennedy, who must still be confirmed by the Senate as Trump’s nominee for HHS secretary, has spoken out about the popularity of the drugs. In speeches and on social media, he has said the U.S. should not cover the drugs through Medicaid or Medicare. Instead, he supports broad expansion of coverage for healthier foods and gym memberships.
“For half the price of Ozempic, we could buy regeneratively grown, organic food for every American, three meals a day and a gym membership for every obese American,” Kennedy told a group of federal workers at a roundtable earlier this year. legislators.
