What’s Behind the Biden Administration’s Push for Weight-Loss Drug Access?

Tablet displaying "Medicare" next to medical equipment.

President Biden proposes Medicare and Medicaid coverage for weight-loss drugs, sparking debate over costs and effectiveness.

At a Glance

Biden administration aims to expand access to weight-loss drugs through Medicare and Medicaid
Proposal could cost taxpayers up to $35 billion over the next decade
Coverage would include drugs like Wegovy and Ozempic for individuals with a BMI of 30 or higher
An estimated 7.5 million people on Medicare and Medicaid could qualify for the drugs
The proposal faces opposition from some who advocate for alternative approaches to obesity

Biden’s Proposal for Weight-Loss Drug Coverage

President Joe Biden has proposed a rule that would allow Medicare and Medicaid to cover weight-loss drugs for obese Americans. This move aims to address the obesity epidemic in the United States, where approximately 42% of adults are classified as obese. The proposal would enable coverage for drugs such as Wegovy and Ozempic, which have shown effectiveness in weight loss but come with a high price tag.

Under the proposed rule, individuals with a body mass index (BMI) of 30 or higher would qualify for coverage. This could potentially benefit an estimated 3.5 million people on Medicare and 4 million on Medicaid. The inclusion of these drugs in government healthcare programs represents a significant shift, as Medicare is currently barred from covering weight-loss drugs due to a decades-old law.

Context for today’s announcement that the Biden Admin wants Medicare and Medicaid to cover drugs for weight loss. Here’s the current state of coverage of these drugs across employer, ACA, and Medicaid plans: https://t.co/bd4d1MgHIV

— Cynthia Cox (@cynthiaccox) November 26, 2024

Financial Implications and Access

The proposal’s potential cost to taxpayers is substantial, with estimates reaching up to $35 billion over the next decade. This hefty price tag reflects the current market for anti-obesity drugs, which has seen significant growth with FDA-approved medications like Wegovy and Zepbound. These drugs typically cost between $1,000 to $1,300 per month, making them inaccessible to many Americans without insurance coverage.

The Biden administration’s move aligns with the President’s focus on reducing prescription drug costs during his tenure. By expanding access to these weight-loss drugs through Medicare and Medicaid, the proposal aims to make effective obesity treatments available to a broader demographic, potentially improving health outcomes for millions of Americans.

Opposition and Alternative Approaches

The proposal has faced opposition, notably from Robert F. Kennedy Jr., who has been critical of pharmaceutical companies and advocates for alternative approaches to addressing obesity. Kennedy argues that the funds could be better spent on providing healthier food options and gym memberships to Americans.

This opposition highlights the ongoing debate about the most effective and cost-efficient ways to combat obesity in the United States. While the Biden administration sees the coverage of these drugs as a necessary step in treating obesity as a medical condition, critics argue for more holistic approaches that address the root causes of obesity, such as diet and lifestyle factors.

Potential Impact on Public Health

Supporters of the proposal, including U.S. Health and Human Services Secretary Xavier Becerra, view this as a significant step forward in addressing the obesity epidemic. The Department of Health and Human Services has expressed support for the plan, citing potential improvements in health and quality of life for those struggling with obesity.

As the proposal moves forward, it will likely continue to generate debate among policymakers, healthcare professionals, and the public. The outcome of this initiative could have far-reaching implications for how obesity is treated and managed within the U.S. healthcare system, potentially setting a new precedent for the coverage of weight-loss treatments in government healthcare programs and other medicines.