Millions of Americans with obesity could soon have their prescriptions for popular weight-loss drugs like Wegovy and Ozempic covered by Medicare and Medicaid, according to a proposal unveiled by the Biden administration. This $35 billion initiative, announced by the U.S. Department of Health and Human Services (HHS), aims to offer access to these injectable medications, which some have dubbed miracle drugs due to their weight-loss effects.
The push for coverage stems from the recognition of obesity as a disease worthy of medical treatment, shifting from previous laws prohibiting Medicare from covering weight-loss products. U.S. Secretary of Health and Human Services, Xavier Becerra, noted, "It's a good day for anyone who suffers from obesity. It's a game-changer for Americans who can't afford these drugs otherwise." Under the new proposal, the inclusion of these medications would potentially expand coverage to approximately 3.5 million individuals on Medicare and 4 million on Medicaid, aligning with recommendations supported by bipartisan lawmakers.
Currently, only those classified as obese—defined as having a body mass index (BMI) of 30 or higher—would be eligible for this coverage. Presently, many people do receive coverage when prescribed these drugs for conditions like diabetes or heart disease, but access is limited for those seeking them solely for weight loss.
The push for broader access reflects trends within the obesity treatment marketplace, where weekly injectable drugs like Wegovy, developed by Novo Nordisk, and Zepbound, produced by Eli Lilly, have garnered attention. Clinical trials indicate these drugs can enable users to shed between 15% and 25% of their body weight by mimicking hormones related to appetite regulation.
Despite the potential benefits, the proposal faces scrutiny and opposition; Robert F. Kennedy Jr., who is poised to lead HHS under the incoming Trump administration, has publicly criticized the idea. He suggests redirecting funds toward promoting healthier eating and fitness access instead of subsidizing medications. Speaking to federal lawmakers, Kennedy championed the idea: "For half the price of Ozempic, we could purchase regeneratively raised, organic food for every American, three meals a day, and provide gym memberships for every obese American."
The costly nature of these weight-loss drugs remains prohibitive for many individuals. A monthly supply of Wegovy can exceed $1,300, and Zepbound’s pricing is similarly high, often leaving the drugs accessible only to the affluent, including celebrities publicly discussing their success with these medications.
Supporters argue covering these medications could save taxpayer dollars by preventing health complications resulting from obesity, thereby reducing long-term healthcare costs associated with obesity-related conditions such as heart disease and diabetes.
The Centers for Medicare and Medicaid Services (CMS) projects there are approximately 28 million individuals on Medicaid who qualify as obese, hinting at wider eligibility beyond the current estimates. If the rule is implemented, it could mark one of the most significant expansions of coverage for obesity treatment seen to date.
While support exists among healthcare providers for easier access to weight-loss drugs, there are still concerns about the medications’ long-term safety and effectiveness. Dr. David Ludwig, from Harvard University, warned against relying solely on medication to tackle obesity, emphasizing the need to understand and address the underlying causes of weight gain, such as access to healthy food and active lifestyles. “Let’s not stop there. Let’s identify what’s causing the problem, and rely on these drugs— which have side effects—less and less over time,” he urged.
Further, some doctors express reservations about prescribing these drugs to older populations, who might experience adverse effects like muscle loss, making them more vulnerable to injuries. Dr. Andrew Kraftson, who works with obese patients at the University of Michigan, stressed the importance of thoughtful prescriptions, highlighting the need for comprehensive evaluations rather than quick prescriptions during brief medical visits.
Ahead of any potential approval, discussions on the Biden administration's proposal will hinge significantly on the stance of Trump’s administration and his imminent health appointees, like Kennedy. Although there’s bipartisan support among lawmakers for covering weight-loss medications, the overall political sentiment within Trump’s circle remains uncertain, especially with rising concerns around government spending and budget cuts.
If the proposal is approved, it could provide millions of Americans with access to effective obesity treatments, fundamentally changing the healthcare coverage dynamic for those affected by obesity.
