Biden proposes Medicare, Medicaid cover pricey weight-loss drugs for obese Americans

WASHINGTON - Popular weight-loss drugs like Wegovy or Ozempic would be covered by Medicare or Medicaid under a new rule proposed Tuesday by the Biden administration.

The drugs, which would give millions of Americans with obesity access to weekly injectables to help them lose weight, would also cost taxpayers as much as $35 billion over the next decade. 

Supporters say it could help save the government from spending billions on treating obesity-linked health issues.

The costly proposal from the U.S. Department of Health and Human Services immediately sets the stage for a showdown between the powerful pharmaceutical industry and Robert F. Kennedy Jr., an outspoken opponent of weight-loss drugs who, as President-elect Donald Trump’s nominee to lead the agency, could block the measure.

"It's a good day for anyone who suffers from obesity," U.S. Health and Human Services Secretary Xavier Becerra told The Associated Press in an interview. "It's a game changer for Americans who can't afford these drugs otherwise."

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A look at the proposed rule

The rule would not be finalized until January, days after Trump takes office. 

A bipartisan coalition of congressional members has lobbied for the drugs to be covered by Medicare, noting that they could help save billions of dollars on treating chronic ailments that stem from obesity – such as heart disease, type 2 diabetes and more.

Medicare has been barred from offering the drugs under a decades-old law that prohibits the government-backed insurance program from covering weight-loss products. The rule proposed by the Biden administration, however, would recognize obesity as a disease that can be treated with the help of medication.

It was unclear where Trump himself stands on coverage of the weight-loss drugs. His allies and Cabinet picks who have vowed to cut government spending could balk at the upfront price tag.

Who would qualify?

Under the proposal, only those who are considered obese — someone who has a body mass index of 30 or higher — would qualify for coverage. 

Some people may already get coverage of the drugs through Medicare or Medicaid, if they have diabetes or are at risk for stroke or heart disease.

Becerra estimated that an additional 3.5 million people on Medicare and 4 million on Medicaid could qualify for coverage of the drugs. But research suggests far more people might qualify, with the Centers for Medicare and Medicaid Services estimating roughly 28 million people on Medicaid are considered obese.

Weight loss drug market growing rapidly

The anti-obesity drug market has expanded significantly in recent years, with the Food and Drug Administration approving a new class of weekly injectables like Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound to treat obesity.

People can lose as much as 15% to 25% of their body weight on the drugs, which imitate the hormones that regulate appetites by communicating fullness between the gut and brain when people eat.

The cost of the drugs has largely limited them to the wealthy, including celebrities who boast of their benefits. A monthly supply of Wegovy rings up at $1,300 and Zepbound will put you out $1,000. Shortages of the drugs have also limited the supplies.

What has RFK said about the drugs?

Kennedy, who as Trump's nominee for HHS secretary is subject to Senate confirmation, has railed against the drugs' popularity. 

In speeches and on social media, he's said the U.S. should not cover the drugs through Medicaid or Medicare. Instead, he supports a broad expansion of coverage for healthier foods and gym memberships.

"For half the price of Ozempic, we could purchase regeneratively raised, organic food for every American, three meals a day and a gym membership, for every obese American," Kennedy said to a group of federal lawmakers during a roundtable earlier this year.