The Biden administration has unveiled a plan to expand Medicare and Medicaid coverage to include popular anti-obesity medications, a move aimed at addressing a rising national health crisis.
The proposed rule, announced Tuesday, would require the programs to cover weight-loss drugs such as Novo Nordisk’s Wegovy and Ozempic and Eli Lilly’s Mounjaro and Zepbound. Medicare has historically excluded weight-loss medications, only covering them when prescribed for other conditions like diabetes or heart disease. Medicaid coverage has largely been left to states, most of which do not include obesity drugs.
Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure framed the initiative as a shift in perspective. “The medical community today agrees that obesity is a chronic disease,” Brooks-LaSure said. “These drugs are the beginning of a revolution in the way that weight is controlled.”
The proposal would classify obesity medications as treatments for chronic disease rather than solely for weight loss. It would expand access to an estimated 7.4 million Medicare and Medicaid beneficiaries, according to government estimates.
Financial Impact
The shift is projected to cost the federal government $25 billion for Medicare and $11 billion for Medicaid over the next decade, with states shouldering $3.8 billion. Despite the high price tag, officials argue the change will not lead to higher premiums for beneficiaries.
Currently, weight-loss drugs can cost $1,000 or more per month, pricing them out of reach for many Americans. The proposal aims to alleviate this burden. “This is a game changer for Americans who can’t afford these drugs otherwise,” Health and Human Services Secretary Xavier Becerra said in an interview.
Legislative and Political Challenges
The rule is subject to a 60-day public comment period and could face hurdles from the incoming Trump administration. President-elect Donald Trump’s nominee for Health and Human Services Secretary, Robert F. Kennedy Jr., has expressed skepticism about covering weight-loss drugs, favoring investments in preventive measures such as healthy food programs and gym memberships.
Kennedy has voiced concerns about the high cost of medications like Ozempic, suggesting funds could be better allocated. “For half the price of Ozempic, we could purchase regeneratively raised, organic food for every American, three meals a day, and a gym membership,” he said earlier this year.
Broader Implications
Obesity affects more than 40% of Americans and is linked to chronic conditions such as diabetes, heart disease, and certain cancers. The proposal could reshape how obesity is treated in the U.S., reducing barriers to medications that help patients lose up to 25% of their body weight.
The CMS estimates that the expanded coverage could particularly benefit adolescents and adults enrolled in Medicaid, as well as individuals with obesity-related conditions such as sleep apnea.
Timeline and Next Steps
If approved, Medicare Part D plans would begin covering the drugs in 2026. It remains unclear when the proposal would take effect for state Medicaid programs. Public comments on implementation timelines are being solicited, with Medicaid officials emphasizing the need for fair pricing from drug manufacturers.
The plan sets the stage for a political and economic debate over how best to address obesity in America, balancing the immediate costs of medication with the long-term savings from managing obesity-related health issues.