Millions of Americans struggling with obesity may soon find relief thanks to a bold proposal from the Biden administration aimed at covering weight-loss medications under Medicare and Medicaid. This initiative, announced by the Department of Health and Human Services (HHS), aligns with the administration's goal of addressing the obesity epidemic affecting so many citizens.
The proposed rule, if finalized, would allow coverage for popular drugs like Wegovy and Zepbound, which are known for their effectiveness at helping users shed significant weight—often referred to as 'miracle drugs' by some. According to U.S. Health and Human Services Secretary Xavier Becerra, this plan is transformative for those who typically cannot afford these medications. “It’s a good day for anyone who suffers from obesity,” Becerra remarked, indicating the potential for improved health outcomes across the nation.
Yet, the proposal is not without its challenges. With the price tag estimated at $35 billion over the next decade, the new coverage could spark tensions between the Biden administration and the incoming Trump administration. President-elect Donald Trump has yet to disclose his position on this proposal, and key figures within his administration, like Robert F. Kennedy Jr., have raised concerns about the drugs' safety and efficacy.
Under the current plan, only individuals classified as obese—those with a body mass index (BMI) of 30 or higher—would qualify for this potential coverage. This could mean approximately 3.5 million Medicare beneficiaries and 4 million Medicaid recipients might become eligible. Still, other experts note this number is likely much higher, as about 28 million Medicaid recipients are estimated to fall within the obesity category, according to the Centers for Medicare and Medicaid Services.
This revised approach to weight-loss medications marks a significant shift—previously, Medicare was barred from covering such drugs due to longstanding regulations. But the Biden administration’s new rule aims to recognize obesity as a treatable medical condition, opening the door for substantial changes.
Both Wegovy, produced by Novo Nordisk, and Zepbound, from Eli Lilly, have gained attention not just for their effectiveness, but for the hefty price associated with their use. Wegovy can cost around $1,300 per month, making it financially out of reach for many who could benefit from it. Anecdotal evidence suggests these medications can lead to weight losses of between 15% and 25%, dramatically altering the lives of those who successfully use them.
Controversy simmers as opponents like Kennedy advocate for alternative approaches to tackling obesity, arguing the government should focus instead on providing healthier food options and promoting physical fitness rather than covering pharmaceuticals. During discussions with lawmakers, Kennedy argued, “For half the price of Ozempic, we could purchase regeneratively raised, organic food for every American, three meals a day, and gym membership for every obese American.”
This sentiment is echoed by others who question the long-term reliance on such medications. Critics point to the necessity of more comprehensive strategies to resolve the issues surrounding obesity—like fostering healthier eating habits and encouraging exercise. Dr. David Ludwig, from Harvard University, emphasizes the importance of research to understand the root causes of rising obesity rates. “It’s appropriate to treat the problems with drugs, but let’s not stop there,” he insists.
The proposal finds support among some Congressional members who believe the long-term savings from preventing obesity-related health issues would offset the upfront costs associated with providing coverage for these drugs. Rep. Brad Wenstrup, who sponsored previous legislation to expand coverage, expressed optimism about the administration's actions, citing the potential to improve health outcomes for many Americans.
Despite the growing support for the Biden administration's proposal, some figures within Trump's circle, including Kennedy, express skepticism. They advocate for reallocation of funds toward nutrition and fitness rather than pharmaceuticals. Emerging leaders within the health sector also share concerns about the necessity of caution. Dr. Andrew Kraftson, who specializes in obesity treatment at the University of Michigan, acknowledges the benefits these drugs can bring, but he urges careful consideration of their use, especially concerning potential side effects among elder patients.
Healthcare providers are watching closely as governmental interpretations of coverage expand or contract. An administration pushing for broad access to effective treatments contrasts with concerns from within about the overall strategy and fiscal responsibility related to obesity treatment. Whether Biden's proposal will gain ground, or fall to the wayside under the new administration, remains uncertain.
