Could Millions of Americans Soon Access Weight Loss Drugs Through Medicare and Medicaid?

A groundbreaking proposal from the Biden administration could dramatically expand access to weight loss medications for millions of Americans. The proposed rule, announced on November 26, 2024, would make these drugs available through Medicare and Medicaid, two crucial federal health insurance programs.

This news comes amidst a growing public health crisis, with obesity rates in the U.S. climbing to 42% of adults, a significant increase from 30% in just two decades.

The pharmaceutical industry has created a new wave of hope with drugs like Wegovy and Zepbound. These medications, classified as GLP-1 receptor agonists, were initially developed to treat diabetes but have proven remarkably effective in assisting weight loss.

These medications work by reducing appetite, leading to significant weight reduction in patients. However, the high cost has made them largely inaccessible to many Americans.

"Americans should just eat better," stated Robert F. Kennedy Jr., President-elect Donald Trump’s pick to lead the Department of Health and Human Services (HHS), raising concerns about the future of this proposal under the incoming administration.

The proposed rule would impact approximately 3.4 million Medicare recipients and 4 million Medicaid recipients. States would have the option to participate in covering the cost of these medications under Medicaid.

Experts estimate the program could cost around $40 billion over the next decade. If finalized, the rule is anticipated to take effect in 2026.

Currently, large employers are increasingly covering GLP-1 drugs for obesity, bridging the affordability gap for some, according to a recent survey by Mercer, a benefits consultant. However, many Americans still struggle to access these medications due to the prohibitive cost.

Expanding Medicare and Medicaid coverage could be a game changer, potentially making these life-altering medications accessible to millions who need them most.

The future of the rule, however, remains uncertain as it awaits a decision from the incoming administration.

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The Price of Hope

Wegovy, manufactured by Novo Nordisk, carries a listed price of $1,349 in the U.S. However, it’s available at a fraction of that cost in Europe. As highlighted in a U.S. Senate committee hearing, Wegovy costs only $92 in the United Kingdom.

Ozempic, another popular GLP-1 drug also made by Novo Nordisk, is listed at nearly $970 per month, highlighting the significant price disparities between the U.S. and other countries. Eli Lilly’s Zepbound, a weigth management medication, comes with an even higher list price of $1,060 for a 28-day supply, according to GoodRX.com.

The high cost of these medications has raised concerns about affordability and equitable access for patients who stand to benefit greatly from them.

The proposed expansion of Medicare and Medicaid coverage aims to address this challenge, potentially making these potentially life-changing treatments available to a broader population of Americans.

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