WASHINGTON — Millions of Americans with obesity would be eligible to have popular weight-loss drugs like Wegovy and Ozempic covered by Medicare or Medicaid under a new rule announced Tuesday by President Joe Biden’s administration.
The Department of Health and Human Services’ costly proposal sets the stage for a possible 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.
Although the rule would give millions of people access to weekly injectables that have helped people lose weight so quickly that some have labeled them miracle drugs, it would cost taxpayers up to $35 billion over the next decade.
“It’s a good day for anyone who suffers from obesity,” Health Secretary Xavier Becerra told The Associated Press in an interview. “It’s a game-changer for Americans who otherwise wouldn’t be able to afford these medications.”
The rule would not be finalized until January, days after Trump takes office. A bipartisan coalition of members of Congress has advocated for the drugs to be covered by Medicare, saying it could save the government billions of dollars in treating chronic diseases caused by obesity. While it’s unclear where Trump himself stands on coverage of weight-loss drugs, his allies and Cabinet picks who have promised to reduce government spending could reject the asking price.
Under the proposal, only those considered obese — someone who has a body mass index of 30 or higher — would qualify for coverage. Some people already have drug coverage 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 drug coverage. But research suggests that many more people could qualify: The Centers for Medicare and Medicaid Services estimates that about 28 million people on Medicaid are considered obese.
Medicare, government-backed insurance, does not cover weight loss products. However, the Biden administration’s proposed rule would recognize obesity as a disease that can be treated with the help of medications.
The anti-obesity drug market has expanded significantly in recent years, with the Food and Drug Administration (FDA) approving a new class of weekly injectables such as Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound to treat obesity.
People can lose 15% to 25% of their body weight with the medications, which mimic hormones that regulate appetite by communicating satiety between the gut and the brain when people eat.
The cost of the drugs has greatly limited their access to the wealthy, including celebrities who boast about their benefits. A monthly supply of Wegovy costs $1,300 and Zepbound will cost $1,000. Its shortages have also limited supplies.
Kennedy, who as Trump’s nominee for health secretary is subject to Senate confirmation, has criticized the drugs’ popularity. In speeches and on social media, he has said that the United States should not cover medications through Medicaid or Medicare. Instead, it supports a broad expansion of coverage for healthier foods and gym memberships.
“For half the price of Ozempic, we could buy regeneratively raised organic food for every American, three meals a day, and a gym membership, for every obese American,” Kennedy told a group of federal lawmakers during a roundtable discussion earlier in this year.