A costly proposal by the US Department of Health and Human Services, the powerful pharmaceutical industry and Robert F. Kennedy Jr., an obvious adversary of weight-loss drugs which, as President-elect Donald Trump’s nominee To lead the department, can try to stop the move.
While the rule would give millions of people access to weekly injections that have helped people shed pounds so quickly that some have labeled them miracle drugs, it would cost taxpayers up to $35 billion over the next decade. There will be a cost.
“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. “This is a game changer for Americans who might not otherwise be able to afford these drugs.”
“This proposal will allow Americans and their doctors to determine the best path forward so they can live healthier lives, without worrying about their ability to pay for these drugs out of pocket, and ultimately our nation.” reduce health care costs for,” the White House said in a statement.
A bipartisan coalition of members of Congress has lobbied for the drug to be covered by Medicare, saying it could save the government billions of dollars in spending to treat chronic diseases caused by obesity.
Who will be eligible to receive weight loss drugs?
Under SuggestionMedicare and Medicaid coverage would be extended to those prescribed drugs “to reduce body weight and maintain long-term weight loss for people with obesity.”
Medicare estimates that most obese enrollees already qualify for other conditions such as diabetes, heart disease or sleep apnea. About 7% of Medicare beneficiaries will be newly eligible. This means that people who are only overweight but not obese will not be covered, unless it is combined with another qualifying condition such as diabetes or heart disease treatment. .
The change also applies to state Medicaid programs, which will no longer be allowed to exclude weight-loss drug coverage for obese residents.
The Centers for Medicare and Medicaid Services estimates that 12% of adults covered by Medicaid will be newly eligible. Adolescents may also be covered, according to the Food and Drug Administration. Approved Use of Vigovi up to 12 years of age.
The anti-obesity drug market has expanded significantly in recent years, with the FDA approving a new class of weekly injections to treat obesity, such as Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound.
People can lose 15% to 25% of their body weight on the drug, which mimics the hormones that control appetite and completes the communication between the gut and the brain when people eat.
The drug’s price has largely restricted it to the wealthy, including celebrities who flaunt their benefits. Wegovy’s monthly supply goes up to $1,300 and Zepbound will set you back $1,000. Drug shortages have also limited supplies.
When does weight loss drug coverage begin?
For Medicare, a proposal to require Part D plans to expand coverage for weight-loss drugs would take effect in 2026. Officials claimed they didn’t think the proposal would significantly increase costs for seniors next year, citing inflation-adjusted provisions. Act
“We do not expect any short-term impact on premiums from this proposal, and in fact, this proposal provides a significant savings for people who are currently paying out-of-pocket for these drugs,” said Dr. Meena Shishmani, MD. Supervising Officer. Medicare, told reporters.
It’s unclear when the proposal will take effect in state Medicaid programs.
Officials at the Centers for Medicare and Medicaid said they are inviting. Public comment When states need to cover expensive drugs.” States are also feeling considerable pressure on state budgets and we are doing our part to ensure that patients, Medicaid enrollees across the country have access to those,” Dean Tsai, the agency’s top Medicaid official, told reporters.
Over the next decade, the proposal would cost the federal government $11 billion and states $3.8 billion, he estimated. Make sure they’re thinking about offering fair, reasonable prices to the Medicaid program,” Sy said.
The path forward in the new administration is not clear.
While it’s unclear where Trump himself stands on coverage of weight-loss drugs, his allies and cabinet picks who have pledged to cut government spending may already be down on the price tag.
Medicare is barred from covering the drugs under a decades-old law that prohibits government-backed insurance programs from covering weight-loss products. The rule proposed by the Biden administration, however, would recognize obesity as a disease that can be treated with medication.
Kennedy, who is subject to Senate confirmation as Trump’s nominee for HHS secretary, has spoken out against the drug’s popularity. In speeches and on social media, he has said that America should not cover drugs through Medicaid or Medicare. Instead, he supports a broad expansion of coverage for healthy meals and gym memberships.
Kennedy told a group of federal lawmakers during a roundtable earlier this year, “For half the price of Ozempic, we could provide every American with regenerated, organic food, three meals a day and every obese American. can buy a gym membership.”
Contributed to this report.