Nov. 26, 2024 – The Biden administration wants to expand coverage for GLP-1 drugs like Ozempic and Wegovy under the Medicare and Medicaid programs.
The drugs previously were not required to be covered due to a tangle of laws and policies, among them one that said Medicare Part D plans cannot cover weight loss drugs.
GLP-1 medicines work by mimicking hormones that affect blood sugar, digestion, and appetite. First approved by the FDA for the treatment of type 2 diabetes, the drugs are now approved to treat obesity and overweight, as well as to reduce the risk of problems with the heart and blood vessels (cardiovascular problems). Research is increasingly linking the drugs to other health benefits, from helping with sleep apnea to knee pain.
In its announcement, the Biden administration called anti-obesity medicines “life-saving drugs,” noting that they can also prevent diabetes.
“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,” the White House’s news release stated, adding that the price of the drugs internationally is lower.
A one-year supply of Wegovy purchased at list price is more than $16,000. The White House said the new plan could reduce out-of-pocket costs by up to 95%, which would mean that a person may then pay around $800 per year for Wegovy, for example.
“It’s unacceptable that Americans – especially those without insurance coverage for these drugs – are forced to pay so much more for life-saving medications,” the news release stated. “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. We can lower drug prices and improve health outcomes for Americans.”
The new coverage would affect about 3.4 million people with Medicare and about 4 million adults who have Medicaid, according to the White House. Estimates have put the cost to Medicare for expanding coverage at $25 billion over a decade, according to The New York Times.
More than 40% of U.S. adults meet obesity criteria, and about 15% of adults have diabetes, although many are not aware and remain undiagnosed. Each condition is linked to serious long-term health risks.
Medicare coverage under Part D plans has previously been limited to GLP-1 drugs that are FDA-approved for non-weight loss conditions, such as treating diabetes or reducing cardiovascular disease risk. But Part D plans are not required to cover GLP-1 drugs at all, just drugs that treat diabetes or cardiovascular disease.
