The Biden Administration introduced a new rule on Tuesday aiming to require Medicare and Medicaid to cover weight loss medications as treatments for obesity, with the potential for this to become effective in 2026.
Currently, these programs only pay for popular glucagon-like peptide-1 (GLP-1) drugs, such as Ozempic, for conditions like diabetes or heart problems, but not for weight loss. If the new rule is approved, people could use their insurance to get these medications specifically for weight management, even if they don’t have another medical condition.
With over 40% of Americans experiencing obesity, this proposal could help around 7 million people gain access to these weight loss drugs. Public interest and support for these GLP-1 medications have been on the rise recently, with about one in eight Americans having tried them.
Initially, GLP-1 drugs were approved for treating type 2 diabetes and obesity but have shown potential in offering additional health benefits, such as reducing cardiovascular disease risk and slowing chronic kidney disease progression. This broader usefulness might be why the Biden Administration is advocating for this rule change.
However, there are concerns about the financial implications. If half of the individuals with obesity on Medicare and Medicaid were to use weight loss medications like Wegovy, it could cost the programs around $166 billion annually. The move would need backing from policymakers, including the Trump Administration, and could face legal challenges.
The proposal from the Department of Health and Human Services (HHS) focuses on significantly expanding access to anti-obesity drugs. Although the benefits of GLP-1 drugs are highlighted, it’s not clear which specific medications would be approved under this new rule or whether Medicare and Medicaid enrollees would face out-of-pocket costs.
The White House describes the proposal as a cost-cutting measure for prescription drugs, potentially reducing out-of-pocket expenses by up to 95% for some enrollees. Medicaid programs in a few states already cover GLP-1s for obesity, but this rule could extend access to millions of additional people.
The change could be crucial since obesity increases the risk of heart disease, type 2 diabetes, and some cancers. More accessible weight loss drugs might help tackle health disparities, particularly benefiting lower-income individuals who currently struggle to afford GLP-1 medications that can cost over $1,000 monthly. Traditionally, higher-income groups have been more frequent users of these drugs, and people of color have historically lower access compared to white Americans.
Experts are unsure how the incoming administration will approach the proposal, as these changes could be met with budgetary concerns and legal challenges. Adjustments in legislation might be needed to allow Medicare and Medicaid to cover weight loss medications legally.
While it’s too early to predict the full impact on Americans’ health if the rule is enacted, the proposal itself signifies a shift in understanding obesity in the U.S., viewing it more as a medical issue rather than solely a behavioral one.
