Medicare and Medicaid would be required to cover injectable versions of semaglutide and tirzepatide deployed in the anti-obesity drugs Ozempic and Mounjaro under plans announced by the Biden administration Tuesday. File photo by Ida Marie Odgaard/EPA-EFE
Medicare and Medicaid would be required to cover weight loss drug prescriptions for millions of obese Americans under plans announced by the Biden administration Tuesday.
The new Health and Human Services rule would extend access to anti-obesity medicines, including Wegovy, Ozempic and Mounjaro, to as many as 3.4 million Americans 65, people with disabilities who receive Medicare and 4 million younger people with low incomes enrolled in Medicaid. Advertisement
Estimates from a White House official show the change would save patients without health insurance, or whose insurance does not cover the drugs, $1,000 or more a month in out-of-pocket expenses and help redress inequity in who gets the medication.
Currently, Medicare and Medicaid recipients are covered when the drugs are prescribed to treat diseases such as diabetes and not for obesity itself.
NBC News quoted data from healthcare analytics provider PurpleLab showing around 85% of semaglutide prescriptions in 2023 were written for White people, leading doctors to identify the high cost of weight loss drugs in the United States as a bar to low and middle-income Americans whose insurance doesn’t cover them.
The drugs sell in Europe for as little as 7% of the U.S. list price. Advertisement
“Our Medicare and Medicaid populations are some of the most at-risk and they do not have access to any anti-obesity medication,” bariatric medicine specialist Dr. Laure DeMattia said.
The health insurance plans of fewer than 20% of large U.S. employers cover the drugs despite 4 in 10 Americans being categorized as obese, a chronic condition that the Centers for Disease Control and Prevention says raises their risk of heart disease, diabetes, breathing problems, stroke and cancer.
The proposal could set the country’s powerful pharma industry on a collision course with the presumptive Health Secretary Robert F. Kennedy Jr. from Day 1 if he is confirmed for President-elect Donald Trump’s new cabinet.
Kennedy, who has been highly critical of the weight loss drugs, could try to block the plan.
