Biden administration’s proposal to have popular weight-loss drugs like Wegovy or Ozempic covered by Medicare or Medicaid.
The rule proposed by the US Department of Health and Human Services could potentially cost taxpayers up to $35 billion over the next decade.
The big picture: Only individuals classified as obese with a body mass index (BMI) of 30 or higher would qualify for coverage under the proposed rule. Some may already receive coverage through Medicare or Medicaid based on existing conditions like diabetes.
- The rule could extend coverage to around 35 million people on Medicare and 4 million on Medicaid for these weight-loss drugs.
- The proposal seeks to recognize obesity as a treatable disease and overturns the ban that prohibited Medicare from covering weight-loss products.
Zoom out: The weight-loss drug market has expanded in recent years, with new injectables like Wegovy and Zepbound approved by the FDA to assist individuals in losing weight.
- These drugs can help patients lose up to 15-25% of their body weight by regulating appetite-related hormones and fullness signals between the gut and brain.
- The cost of these drugs, amounting to $1,300 monthly for Wegovy and $1,000 for Zepbound, has restricted access to those who can afford it, leading to limited supplies.
