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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.
Although Medicare is not allowed by law to cover weight-loss drugs, the Centers for Medicare and Medicaid Services has proposed reinterpreting the law to cover obesity treatment as a chronic disease, he said.
“The medical community today agrees that obesity is a chronic disease,” agency administrator Chiquita Brooks-Lasure told reporters. “It is a serious disease that increases the risk of premature death and can lead to other serious health problems, such as heart disease, stroke and diabetes.”
By 2022, 22 percent of Medicare enrollees will be diagnosed with obesity, more than double the number a decade ago, she said. A total of 40% of American adults are obese.
The expanded coverage, which will begin in 2026, will not reach people who are obese.
The redefinition also applied to the Medicaid program, meaning the interventions could no longer be excluded from coverage when used as obesity treatments for overweight and long-term weight loss.
Expanding Medicare coverage would cost an estimated $25 billion over a decade and shouldn't have a short-term impact on drug plan premiums, Centers for Medicare and Medicaid Director Meena Seshamani told reporters. Expanding Medicaid coverage would cost the federal government $11 billion and $3.8 billion over ten years, according to Dan Tsai, director of the Centers for Medicaid and CHIP Services.
Whether the proposal will be implemented is an open question, as it is unlikely to be finalized before President Joe Biden leaves office in January.
The incoming Trump administration may not see expanded coverage of anti-obesity drugs as a good thing. President-elect Donald Trump is not a fan of Robert F. Kennedy Jr., his pick to lead the Department of Health and Human Services. RFK Jr Failure to accept the medication In an interview with Fox News last month, he said the best and least expensive way to tackle obesity would be to provide Americans with good food.
However, Dr. Mehmet Oz, whom Trump has tapped to lead the Centers for Medicare and Medicaid Services, has touted anti-obesity drugs on talk shows and on social media.
“For those who want to lose a few pounds, Ozempic and other semaglutide drugs can be of great help,” Oz. Posted Last year on Instagram. We need to make it as easy as possible for people to meet their health goals, their periods.
Trump's transition team did not immediately respond to a request for comment.
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.
The Center for Medicare and Medicaid Services has opened its doors 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.
This story has been updated with additional developments.