November 26, 2024
President Biden is not going away quietly – he just proposed a new rule to have Medicare and Medicaid cover weight loss drugs like Ozempic and Wegovy starting in 2026.
Now – hang on partner – this may never actually become a thing – and I’ll tell you why in a minute.
But first – the White House released this proposed rule this morning from the Health and Human Services department. The White House says tens of millions of Americans – about 42%– struggle with obesity and the Biden Administration considers obesity a chronic disease that increases your chances of developing other comorbidities like diabetes, heart disease, stroke and some cancers.
The White House says by covering these GLP-1 medications on the front end – those comorbidities may not develop in the first place so it will save the government from paying for even more expensive treatments on the back end. Of course these medications are already covered by Medicare and Medicaid but only to treat conditions like diabetes. This new proposal would change the rule and expand the access and allow them to be prescribed and covered to treat obesity too. That means it would only be covered if a doctor determines a person has a body mass index of 30 or higher.
Most of you already know these medications are super expensive – sometimes costing $1000 a month. So if this proposal goes forward, for Medicare enrollees it would bring down the out-of-pocket costs by as much as 95% and those on Medicaid would get access to them too. And if they’re covered by Medicare and Medicaid – it increases the chance of them ultimately being covered by your own health insurance to treat obesity.
Now – a couple of things. One – there is a decades old law called the Social Security Act that says Medicare and Medicaid cannot cover drugs specifically for “weight loss.” But under this proposed rule the Biden Administration is saying obesity is a disease and medications that treat is should be covered like other medications used to treat other diseases. We’ll see if that flies.
And the other more important part of all this – this proposal needs to go through the regulatory process which means it will stretch into the trump administration. So it will be up to trump’s team to follow through with the regulation. Or not. Plus it’s worth noting – that RFK Jr. –Trump’s pick to lead health and human services is not a fan of these drugs and he’s said publicly many times –the government should not cover these drugs and instead should support broad expansion of coverage for healthier foods and gym memberships.
Read more from the White House on this move here.
Read more from HHS on this move here.
Read the proposed rule here.
