Source: STAT News
WASHINGTON — The Biden administration is proposing a major expansion of how Medicare and Medicaid cover the blockbuster weight-loss drugs Wegovy and Zepbound, the White House announced Tuesday.
Medicare currently covers the medications, made by Novo Nordisk and Eli Lilly, to treat diabetes and heart disease, but not for obesity alone because it’s prohibited by law from doing so. Medicare officials are aiming to expand coverage to all people with obesity in Medicare and Medicaid by reinterpreting the law.
The future of the policy is precarious, given the Biden administration waited so long to start the policymaking process that the incoming Trump administration would have to finalize it. The abrupt shift on weight-loss drugs comes too late for President Biden or Vice President Harris to benefit politically, but could create some public pressure for the new Trump team to carry it forward.
Given the potential price tag, a bill in Congress to extend coverage of weight-loss drugs in Medicare has stalled for more than a decade. The Congressional Budget Office estimated last month that a coverage expansion to Medicare could cost the federal government $35 billion over a decade, though that number includes coverage for some people who are overweight, as well. Medicare’s estimate for the cost of its policy is $25 billion over a decade.
The White House estimates the new proposal would provide coverage to an estimated 3.4 million older adults in the Medicare program, and 4 million people in Medicaid. The proposal would go into effect in 2026.
