The Biden administration plans to require Medicare and Medicaid to offer coverage of weight loss medications for patients seeking to treat obesity.
The new rule, which was proposed by the administration on Tuesday, would dramatically expand access to anti-obesity medications like Wegovy, Ozempic and Mounjaro.
Until now, Medicare and Medicaid have only provided insurance coverage for these drugs when they are used to treat conditions like diabetes.
The change would dramatically reduce out-of-pocket costs for the drugs. Today, a month’s supply of weight loss drugs can cost $1,000 or more, according to estimates from a White House official.
More than that 40% of Americans are considered obese. Obesity, a chronic disease, puts people at risk for heart disease, diabetes, breathing problems, stroke and some cancers, according to the Centers for Disease Control and Prevention.
The new rule would expand access to the drugs for 3.4 million Americans who use Medicare and another 4 million people enrolled in Medicaid, the White House official said.
About 72 million Americans were enrolled in Medicaid as of July, according to the Centers for Medicare & Medicaid Services. Nearly 68 million are enrolled in Medicare.
Another 154 million Americans get health insurance through their work, according to KFFa nonpartisan health care policy research group.
Research suggests there are significant disparities in who receives weight loss drugs. The health care analytics company PurpleLab found racial disparities in who is able to get semaglutide, the ingredient in Ozempic and Wegovy.
About 85% of semaglutide prescriptions were dispensed to white people in 2023, the company’s data found. When insurance doesn’t cover the drug, its high cost becomes a barrier for many low- and middle-income Americans, doctors have said.
Expanding coverage to patients who rely on Medicare and Medicaid could reduce some disparities.
“Our Medicare and Medicaid populations are some of the most at-risk and they do not have access to any anti-obesity medication,” Dr. Laure DeMattia, a bariatric medicine specialist in Norman, Oklahoma, told NBC News in March.
The issue is fast becoming a workplace matter, too, as the drugs’ popularity increases and employers balance program costs and their workers’ needs.
Survey results published last month in Health Affairs found that less than a fifth of large companies in the US offered health insurance plans that covered weight loss drugs.
Weight loss drugs like Wegovy are injectable medications of semaglutide. The drugs work because they mimic a hormone called GLP-1, which helps control blood sugar, manage people’s metabolism and help them feel full.
Drugmakers are working on dozens more GLP-1 drugsstudying their long-term effects and exploring how they might help with other conditions.
Studies have suggested these types of drugs could help people cut back on alcohol and reduce sleep apneaamong other uses.