The Biden administration’s ambitious plan to include obesity medications under Medicaid and Medicare coverage sparks debate on healthcare costs and benefits.
At a Glance
- Biden administration reinterprets federal law to cover obesity medications under Medicare and Medicaid.
- The proposed rule is estimated to cost $36 billion over the next decade.
- Public input and political developments could influence the implementation of the proposal.
- Concerns about soaring Medicare premiums if drug pricing issues remain unaddressed.
Obesity Medications as a Chronic Illness
The Biden administration aims to address the obesity epidemic by expanding Medicaid and Medicare to include drugs like Ozempic and Wegovy. With over 40% of U.S. adults suffering from obesity, the initiative could significantly lower out-of-pocket costs for patients. The change would reinterpret Medicare Part D’s existing exclusions to include these crucial medications for seniors and low-income individuals.
CMS Administrator Chiquita Brooks-LaSure stated, “People with obesity deserve to have affordable access to medical treatment and support, including anti-obesity medications; just as a person with type two diabetes can access these medications to get healthy.” The proposed rule aims to recognize obesity as a chronic disease, aligning with the medical community’s consensus.
Medicare and Medicaid would cover weight-loss drugs like Wegovy and Ozempic under a new rule proposed by President Joe Biden on Tuesday. https://t.co/F1GAda6jz0 https://t.co/F1GAda6jz0
— Forbes (@Forbes) November 27, 2024
Financial Impacts and Concerns
The financial implications of this plan are significant. The Centers for Medicare and Medicaid Services (CMS) estimate it will cost $25 billion for Medicare and incur an additional $11 billion in federal spending for Medicaid over the next decade. Critics, including Senator Bernie Sanders, voiced concerns over the high costs of these medications, possibly leading to increased Medicare premiums.
Additionally, less than 20% of large U.S. companies include weight management drugs in their health insurance plans. Proponents argue that expanding coverage could ease personal healthcare expenditures, though it raises concerns about the broader impact on the Medicaid and Medicare financial frameworks.
Millions of Americans with obesity would be eligible to have weight-loss drugs like Wegovy and Ozempic covered by Medicare and Medicaid under a new rule proposed by the Biden administration. CBS News' chief medical correspondent @DrLaPook explains how the proposal works. pic.twitter.com/qNDrBK0KFc
— CBS Evening News (@CBSEveningNews) November 27, 2024
Looking Forward: Implementation and Feedback
The proposal is still in its early stages and was open to public comment for 60 days. The CMS has encouraged states to weigh in on Medicaid implementation specifics, with many aspects hinging on forthcoming political and healthcare policy developments during the incoming Trump administration.
Experts suggest that broader recognition of obesity as a chronic disease marks progress, adding that durable solutions will require comprehensive strategies, including addressing racial disparities and expanding access to populations most at risk.
