The Biden administration has proposed a plan that could allow millions of senior citizens and lower-income Americans to access costly anti-obesity drugs. This initiative, announced on November 26, 2024, aims to expand coverage for approximately 7.4 million individuals under Medicare and Medicaid, potentially reducing out-of-pocket costs significantly.
- Biden administration proposes anti-obesity drug coverage
- Millions of seniors and low-income Americans affected
- High costs limit access to medications
- Medicare coverage for Wegovy expanded recently
- Potential $3 billion annual cost to Medicare
- Only 13 states currently cover GLP-1 medications
The proposal by the Biden administration seeks to address the high costs associated with anti-obesity drugs, which can reach up to $1,000 a month for uninsured individuals. The White House estimates that about 3.4 million Medicare beneficiaries and 4 million Medicaid recipients would benefit from this initiative. Some Medicare enrollees could see their out-of-pocket costs drop by as much as 95%, making these medications more accessible to those who need them.
Currently, Medicare is prohibited from covering obesity drugs, but the Centers for Medicare and Medicaid Services has recently opened the door for coverage of certain medications like Wegovy for eligible enrollees. The high price of these drugs, including GLP-1 medications like Wegovy and Zepbound, has limited access for many Americans. For instance, Wegovy’s list price is approximately $1,350 for a four-week supply.
While the proposal aims to improve health outcomes and reduce overall healthcare costs, it lacks specific details regarding which drugs will be included and the criteria for eligibility. The expansion could potentially cost Medicare nearly $3 billion annually, and the Congressional Budget Office has estimated that fully expanding coverage could amount to $35 billion over nine years. Meanwhile, only 13 states currently cover GLP-1 medications for obesity treatment, with many others considering adding coverage but expressing concerns about costs.
The Biden administration’s proposal represents a significant shift in how anti-obesity medications could be covered under Medicare and Medicaid. While the potential benefits are substantial, the lack of detailed information and the uncertainty surrounding the proposal’s finalization remain critical points of concern.
