Millions of obese Americans would have weekly access to popular injectables that would help them shed pounds quickly, if they had a dollar. 35,000 million proposal It is blessed by President-elect Donald Trump from the Biden administration.
The rule introduced by the Department of Health and Human Services on Tuesday would require Medicare and Medicaid to cover weight-loss drugs like Wegovy or Zepbound for a large segment of Americans who are obese.
But it’s unclear whether the proposal, which won’t take effect until Trump takes office, will have the support of his new administration, Robert F. Kennedy Jr. including opponents of the drugs he has used to serve the president-elect. As head of HHS.
Here’s what you need to know about the drugs and the Biden administration’s proposal:
What is Ozempic and how does it work?
Weight-loss drugs, also called anti-obesity drugs or GLP-1s, mimic a hormone known as glucagon-like peptide 1, which regulates appetite by communicating fullness between the gut and the brain when people eat.
The drugs are Novo Nordisk’s Wegovy and Ozempic and Eli Lilly’s Zepbound and Mounjaro.
In clinical trials, most participants Taking Wegovy or Mounjaro to treat obesity, on average, he lost 15% to 22% of his body weight, in many cases, 50 kilos or more. But none of the “non-responders” lost significant body weight.
Private health insurance has limited drug coverage. Medicare has been barred by a law that says the program can’t pay for weight loss products. Medicaid coverage, on the other hand, has varied from state to state.
This means that the drugs (which can cost more than $1,000 a month) have become unaffordable for many.
Will Medicare and Medicaid cover Ozempic?
The rule announced Tuesday affects Medicaid, which provides health care to about 70 million Americans, and Medicare, the health insurance program for 67 million older Americans.
Under the proposal, the Centers for Medicare and Medicaid Services, or CMS, would reinterpret federal law to include the drug as a treatment for obesity.
The nation’s top health agency estimates that 3.5 million people could get drug coverage under Medicare and 4 million under Medicaid. But research suggests many more people may qualify, with the Centers for Medicare and Medicaid Services estimating that about 28 million people on Medicaid are considered obese.
And the proposal would cost a lot of money, at least $35 billion over the next decade.
RFK Jr. doesn’t want Medicare to cover Ozempic
Drugs are popular – most of them Americans call the health company KFF earlier this year that Medicare should cover the drugs in a survey. A bipartisan coalition of lawmakers has also lobbied for drug coverage.
But support is mixed in Trump’s inner circle.
Kennedy has opposed the idea of Medicare or Medicaid covering drugs. Instead, he told Congress, they should expand coverage of healthier foods and gym memberships through government-sponsored health programs.
Meanwhile, Dr. Mehmet Oz, who is set to take over the leadership of CMS, said that drugs can be a helpful tool. In a video posted on this Instagram last year, Oz praised some of the drug’s benefits, but said the long-term effects needed further study.
“I think these new generations of drugs offer us a tremendous opportunity,” Oz said.
Either Trump or Kennedy could ultimately ignore Biden’s proposal and not comply.
Some lawmakers praised the move on Tuesday, while others expressed skepticism.
Rep. Brad Wenstrup, a Republican who sponsored a bill to cover Medicare weight loss drugs, has argued that covering the drugs and other obesity treatments could save taxpayers in the long run.
“I’m encouraged to see the administration support our efforts to help Americans be healthier by enabling Medicare coverage of new FDA-approved, physician-prescribed anti-obesity medications,” Wenstrup said in a statement.
He asked Congress to pass legislation that would help pay for dietitians, nutritionists and behavioral therapy to treat obesity.
Senator Bernie Sanders, however, warned that unless the government asked drugmakers to lower drug prices, Medicare premiums would “go up” under the plan.
Is Ozempic safe? Doctors still have some concerns
It’s good that more Americans have access to these effective drugs, but Dr. David Ludwig, a nutrition and obesity expert at Harvard University, hopes they won’t be the first way to treat obesity in America.
He worries that not enough is being invested in understanding why obesity rates are rising in the US, and the role that healthy food and exercise can play in solving this epidemic.
“It’s appropriate to deal with our drug problems now, but let’s not stop there,” Ludwig said. “Let’s identify what’s causing the problem, and ultimately let’s rely on these drugs with side effects less and less of the time.”
Dr. Andrew Kraftson, who treats obese patients at the University of Michigan, is happy that more of his patients will be able to afford these drugs that have been prescribed to patients and have had successful results. But he, too, would like more government research and guidance on prescribing medications.
Kraftson also worries about some of the side effects in older patients. The drugs, he notes, can lead to muscle loss, which is a bigger problem for older Americans who are at risk of falling, for example.
“I’m advocating for their thoughtful use,” Kraftson said. “If you have an elderly person and you just write a prescription and the visit takes five minutes, is that the right level of care? Have we defined that correctly?
