Biden administration proposes expanding obesity drug coverage under Medicare and Medicaid

(WASHINGTON) -- The Biden administration has proposed a new rule to “significantly” expand coverage of anti-obesity medications for Americans with Medicare and Medicaid, according to the White House.

“Over the past few years, there have been major scientific advancements in the treatment of obesity, with the introduction of new life-saving drugs,” the White House said in a statement released on Tuesday. “These anti-obesity medications can help prevent the development of Type 2 diabetes. Furthermore, these drugs reduce deaths and sickness from heart attack and other cardiovascular outcomes by up to 20%. But for too many Americans, these critical treatments are too expensive and therefore out of reach. Without insurance coverage, these drugs can cost someone as much as $1,000 a month.”

Millions of Americans struggle with obesity -- an estimated 42%, according to the White House -- and it is now widely recognized as a chronic disease with increased risk of all-cause mortality and multiple related comorbidities such as diabetes, cardiovascular disease, stroke and some cancers.

Medicare and Medicaid currently cover the use of anti-obesity medication for certain conditions, like diabetes. But the new proposal on Tuesday would “expand access to these innovative medications for obesity, which is widely recognized as a disease and help an estimated 3.4 million Americans with Medicare,” the White House said.

“Medicare coverage would reduce out-of-pocket costs for these prescription drugs by as much as 95 percent for some enrollees. Approximately 4 million adult Medicaid enrollees would also gain new access to these medications,” the White House continued.

The proposal would “allow Americans and their doctors to determine the best path forward so they can lead healthier lives, without worrying about their ability to cover these drugs out-of-pocket, and ultimately reduce health care costs to our nation,” White House officials said.

The proposed rule would be implemented at the same time as a comprehensive agenda to lower the costs of drugs, including the drug price negotiation program and increased market competition.

“Thanks to the President’s efforts, seniors are already seeing lower prescription drug costs with insulin capped at $35, free vaccines, and out-of-pocket costs for prescription drugs capped at $2,000 starting in 2025,” the Biden administration said. “Already this year, nearly 1.5 million people with Medicare Part D saved nearly $1 billion in out-of-pocket prescription drugs costs in the first half of 2024 because of the Biden-Harris Administration’s Inflation Reduction Act. Furthermore, HHS has reached agreement with drug manufacturers for the first ten negotiated drugs, with new prices that are reduced between 38 to 79 percent starting in 2026.”

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