Weight-loss drugs/ Medicare obesity coverage/ Wegovy/ Zepbound/ Biden healthcare policy/ WASHINGTON/ Newslooks/ J. Mansour/ Morning Edition/ President Joe Biden has proposed a new rule to allow Medicare and Medicaid to cover popular weight-loss drugs, such as Wegovy and Zepbound, for obese Americans. The move could benefit millions but may cost taxpayers up to $35 billion over the next decade. The proposal, set for finalization in January, faces opposition from President-elect Donald Trump’s nominee for Health and Human Services, Robert F. Kennedy Jr., who has criticized the drugs and advocates for alternative approaches to tackling obesity.
Medicare Coverage for Weight-Loss Drugs: What You Need to Know
Quick Looks
- Proposed Coverage: Medicare and Medicaid could cover costly obesity treatments like Wegovy and Zepbound.
- Potential Cost: Taxpayer burden may reach $35 billion over the next decade.
- Eligibility: Only individuals with a BMI of 30 or higher qualify under the rule.
- Kennedy Opposition: Trump’s HHS pick prefers alternatives like gym memberships and organic food subsidies.
Biden Proposes Medicare, Medicaid Coverage for Weight-Loss Drugs
Deep Look
The Biden administration proposed a groundbreaking rule on Tuesday that would expand Medicare and Medicaid coverage to include costly weight-loss drugs such as Wegovy and Zepbound. If finalized, the rule could make the drugs accessible to millions of obese Americans, marking a significant shift in federal healthcare policy.
While the proposal aligns with growing calls to recognize obesity as a treatable disease, it also sets up a political clash with President-elect Donald Trump’s incoming administration. Trump’s nominee for Health and Human Services (HHS) Secretary, Robert F. Kennedy Jr., has been a vocal critic of weight-loss medications, suggesting alternative approaches to address the obesity epidemic.
A Game-Changer for Obesity Treatment
The new rule, announced by Health and Human Services Secretary Xavier Becerra, would overturn a decades-old law that prevents Medicare from covering weight-loss drugs. Currently, Medicare and Medicaid only cover such treatments for patients with diabetes or conditions like heart disease.
Under the proposed changes:
- Coverage would be extended to individuals with a Body Mass Index (BMI) of 30 or higher.
- An estimated 3.5 million Medicare recipients and 4 million Medicaid enrollees could gain access to the drugs.
- A broader population of 28 million Medicaid users considered obese may qualify based on BMI thresholds.
“This is a game-changer for Americans who can’t afford these drugs otherwise,” said Becerra.
The Cost of Coverage
The price tag for the proposal is significant. Over the next decade, covering the medications could cost taxpayers up to $35 billion, a figure that may draw scrutiny from budget-conscious lawmakers.
- Wegovy, manufactured by Novo Nordisk, costs approximately $1,300 per month.
- Zepbound, by Eli Lilly, is slightly less expensive at $1,000 per month.
These drugs have been lauded for helping users lose 15% to 25% of body weight, mimicking hormones that signal fullness to the brain. However, access to the treatments has largely been limited to wealthy patients and celebrities due to high costs and ongoing shortages.
Kennedy’s Opposition
Robert F. Kennedy Jr., Trump’s HHS nominee, has criticized the widespread adoption of weight-loss drugs. He argues that taxpayer dollars would be better spent on initiatives to improve access to healthy foods and fitness programs.
Kennedy’s remarks include:
- A call to redirect funds toward regeneratively raised organic food and gym memberships for Americans battling obesity.
- A claim that such alternatives could be delivered “for half the price of Ozempic.”
Kennedy’s opposition sets the stage for a potential clash when he assumes office in January, as his confirmation would give him authority to block or amend the proposed rule.
Why the Proposal Matters
The Biden administration has framed the measure as a long-term cost-saving initiative. Proponents argue that effective obesity treatments could reduce government spending on chronic health conditions such as:
- Diabetes
- Heart Disease
- Stroke
A bipartisan coalition of lawmakers has also supported expanding access to anti-obesity drugs, citing the potential to mitigate billions in future healthcare expenses.
The Rising Popularity of Weight-Loss Drugs
The anti-obesity drug market has grown exponentially in recent years, fueled by FDA approvals and celebrity endorsements. Drugs like Wegovy and Zepbound have been labeled “miracle treatments” for their ability to achieve significant weight loss.
Still, skepticism remains:
- Critics point to the high cost and limited supply as barriers to widespread adoption.
- Others argue that drugs alone are insufficient without addressing broader lifestyle factors contributing to obesity.
What’s Next?
The rule is not slated for finalization until January, just days after President-elect Trump assumes office. While Trump has yet to comment on the proposal, his allies have signaled potential resistance due to the high upfront costs.
For now, millions of Americans living with obesity—and the pharmaceutical companies manufacturing these drugs—are watching closely to see whether the policy will survive the incoming administration’s scrutiny.
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