Biden administration pushes for coverage of obesity drugs in Medicare and Medicaid

In recent months, the Biden administration has put forth a proposal aimed at changing the longstanding prohibition on coverage for obesity medications in Medicare, the federal government insurance program for elderly and disabled individuals. This proposed rule is a significant shift from over two decades of regulation that excluded such treatments from coverage. The Centers for Medicare and Medicaid Services (CMS) has stated that the proposal responds to a growing acknowledgment among health experts that obesity is a chronic disease linked to numerous health risks, including diabetes, cardiovascular diseases, and certain cancers. The proposed coverage would apply to patients with a body mass index (BMI) of over 30 and is set to extend also to Medicaid, which serves low-income individuals across the United States. Currently, coverage for obesity medications is limited, existing in only a handful of states under Medicaid, while Medicare has only very restricted coverage for Wegovy, a drug indicated for weight loss in patients at risk of cardiovascular complications. Additionally, the new rule deviation would not cover medications for those classified as overweight with a BMI of under 30, as stipulated by FDA labeling. The process of finalizing this proposal involves a 60-day public comment period, after which the incoming Trump administration will need to decide on the implementation of the rule, scheduled for 2026. The political climate surrounding this initiative remains uncertain, especially with potential opposition from some members of the incoming administration. Notably, Mehmet Oz, the nominee for CMS administrator, has expressed support for the usage of weight loss drugs, while Robert F. Kennedy Jr., who may lead the Department of Health and Human Services, is known for his criticism of obesity drugs. Critics highlight the financial implications of this proposed rule, estimating the cost of expanded coverage to be around $25 billion for Medicare and $11 billion for Medicaid over a decade. The broader context of this proposal includes existing legislative efforts like the Treat and Reduce Obesity Act, which has struggled to advance in Congress but aims to eliminate the long-standing prohibition on Medicare coverage for weight loss drugs. The interplay between these legislative efforts and the new proposal could define the future landscape of obesity treatment in the U.S. amid ongoing debates on the management of obesity as a public health concern.