The Department of Health and Human Services proposed requiring federal and state health insurance programs to cover weight loss drugs for enrollees.
On Tuesday, the Biden administration’s top health agency announced it planned to reinterpret existing rules to require Medicare and Medicaid to cover costs for Ozempic, Mounjaro, and Wegovy for people insured under the health programs.
Current rules block coverage for weight loss drugs. But the Biden administration’s rule change would expand access to prescription drugs for 3.4 million people who are enrolled in Medicare and another 4 million people who use Medicaid, the White House said.
The move could reduce out-of-pocket costs for weight loss drugs by 95% for some enrollees under Medicare coverage. The changes across the board would apply only to obese people, while enrollees who are overweight would not be eligible for coverage unless they have another condition, such as diabetes.
The news follows the release of a study this month showing roughly 75% of adults living in the United States are obese or overweight.
The plans from the Biden administration’s HHS come on the heels of criticism Ozempic and other weight loss medications have received in recent months, particularly from President-elect Donald Trump’s nominee to head the health agency during his second term.
During a congressional hearing last month, Robert F. Kennedy Jr. suggested that Washington lawmakers and the medical establishment are pushing Ozempic because Novo Nordisk, the drug’s manufacturer, is “one of the largest funders of medical research.”
Lamenting when he endorsed Trump in August that sick people are “the best thing for the pharmaceutical industry” because “they are put on medications for their entire life,” Kennedy added, “Imagine what will happen when Medicaid starts paying for Ozempic, which costs $1,500 a month and is being recommended for children as young as six. All for a condition, obesity, that is completely preventable and barely even existed a hundred years ago.”
Rather than the Biden administration’s approach of pursuing weight loss drugs to treat obesity, which is categorized as a chronic disease, Kennedy indicated he would pursue an “organic food” plan as head of the HHS.
“Since 74% of Americans are obese, the costs [for Medicaid to cover Ozempic] could be as high as $3 trillion a year. With a fraction of that money, we could buy organic food for every American and get rid of diabetes altogether,” he said.
The majority of state Medicaid programs do not cover weight loss drugs only for obesity, while Medicare only covers weight loss drugs for obese or overweight people with a diagnosis of diabetes or cardiovascular disease. The White House said Tuesday that the medications currently cost enrollees “as much as $1,000 a month.”
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Sen. Bernie Sanders (I-VT) criticized Novo Nordisk CEO Lars Fruergaard Jørgensen regarding the high costs for Ozempic and Wegovy during a Senate hearing in September, saying, “Stop ripping us off.”
His words come as lawmakers have pushed for more than a year for the Treat and Reduce Obesity Act of 2023, which would require insurance companies to cover the cost of Ozempic.