Trump refuses Medicare proposals to include Wegovy and other medications for obesity

The Trump administration rejected the Biden plan on Friday, which proposed Medicare and Medicaid covering obesity drugs and increasing access to millions of people.

The Biden administration’s proposal aimed to circumvent the ban on Medicare paying for weight loss drugs by claiming they would treat diseases related to obesity.

Expanding drug coverage would cost the federal government billions of dollars, with an estimated cost of around $35 billion over a decade according to the Congressional Budget Office Estimates.

The decision was part of a larger set of regulations contained in a 438-page document aimed at updating Medicare benefits and private insurance plans used by about half of Medicare beneficiaries.

Catherine Howden, a spokesperson for the Centers for Medicare and Medicaid Services, stated that the agency did not believe it was appropriate at the time to approve the Biden plan.

Medicare currently covers a limited set of weight loss medications for individuals with specific health conditions, such as diabetes and heart problems.

The Biden plan aimed to extend coverage to obese patients without these specific diseases, with an estimated 3.4 million people potentially benefiting from the policy.

Popular weight loss pills like Wegovy by Eli Lilly and other related products are now available at reduced prices to patients paying out of pocket.

Eli Lilly and Novo Nordisk offer discounts for their products to patients paying out of pocket instead of through insurance, significantly reducing the cost for individuals.

Health Secretary Robert F. Kennedy Jr. criticized weight loss pills, advocating for a diet of healthy foods instead.

Clinical trials have shown benefits of weight loss drugs beyond just weight loss, including preventing heart attacks and strokes.

Supporters of expanded drug coverage argue that the long-term health benefits will outweigh the costs, potentially reducing overall medical expenses. However, the realization of such savings remains uncertain.

States’ Medicaid programs now have the option to decide whether to cover obesity drugs or not, with some already opting to provide coverage. If the Biden policy had been implemented, all states would have been required to provide coverage.

The exact cost of obesity drugs for Medicare and Medicaid patients is undisclosed, but it is estimated to be several hundred dollars per patient per month.

Many employers and private health insurance plans do not cover weight loss drugs, leading some to discontinue coverage due to high costs.

Patients without insurance often rely on cheaper generic versions of drugs created through compounding, costing less than $200 a month. However, regulators are phasing out this option due to improved supply of branded products.

Congressional Republicans have shown some interest in urging Medicare to cover weight loss drugs, although this is not a current priority. Negotiations with Novo Nordisk for lower drug prices under a 2022 law have been initiated, with reduced prices scheduled to start in 2027 for eligible individuals.