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Millions more elderly and low-income Americans could get coverage for expensive anti-obesity drugs under a proposal announced Tuesday by the Biden administration.
About 3.4 million Medicare beneficiaries and about 4 million Medicaid recipients get these drugs, which can cost the uninsured about $1,000 a month, the White House said in a fact sheet. Some Medicare enrollees could see their out-of-pocket costs drop by as much as 95 percent.
“This proposal will allow Americans and their doctors to decide the best way forward to lead healthy lives without worrying about their ability to cover these drugs out of pocket,” the administration said.
The White House announcement lacked many details about the proposed legislation, including which drugs would be covered, who would be eligible and how much it would cost. It's unclear whether the proposal can be finalized before President Joe Biden leaves office in January.
The high cost of anti-obesity drugs, including the GLP-1 drugs Wegovy and Zepbound, has limited Americans' access to the drug. For example, Wegovy's list price is $1,350 for a four-week supply.
Medicare is prohibited by law from covering obesity medications. But the Centers for Medicare and Medicaid Services opened the door Cover of Wegovy For Medicare enrollees in March after the US Food and Drug Administration He approved the medicine For adults with cardiovascular disease or who are overweight. Many insurers that offer Medicare Part D drug plans have since said they will cover the drug.
In Care Of 3.6 million Medicare enrollees You may be newly eligible for Wegovy if you have cardiovascular disease, such as a Analysis of KFF Released in April. That's about a quarter of Medicare enrollees who are obese or overweight. (About 1.9 million tubers in this group had diabetes and may have been eligible for Medicare coverage for other GLP-1 diabetes drugs, such as Ozempic.)
The coverage expansion could cost Medicare nearly $3 billion a year and contribute to higher Part D premiums for all beneficiaries, a KFF analysis found.
Fully expanding GLP-1 coverage would cost overweight or obese Medicare enrollees $35 billion over nine years, with little to no savings from improved health, according to a recent study. Report From the Congressional Budget Office.
Meanwhile, only 13 states cover GLP-1 drugs for obesity treatment. According to KFF. The half of states that don't currently cover the drug say they are considering adding it, but many are concerned about the cost.
Not all Employment-based health insurance plans Cover anti-obesity drugs, although larger employers are more likely to offer the benefit. KFF annual 18% of organizations Employer health benefits surveyIt includes those with 200 or more employees, covering GLP-1 drugs mainly for weight loss. About a quarter said they were very or very unlikely to start coverage next year.