Biden Seeks Coverage for GLP-1 RA Medications by Medicare, Medicaid

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Medically reviewed by Carmen Pope, BPharm. Last updated on Nov 27, 2024.

By Physician’s Briefing Staff HealthDay Reporter

TUESDAY, Nov. 26, 2024 -- The Biden administration is proposing Medicare and Medicaid coverage for glucagon-like peptide 1 receptor agonist (GLP-1 RA) obesity medications like semaglutide (Wegovy) and tirzepatide (Zepbound), challenging a two-decade-old law and facing probable opposition from the incoming Trump administration.

Right now, a law passed by Congress two decades ago prevents Medicare and Medicaid from covering any "weight loss" drug. Under the Biden proposal, that rule would be circumvented by calling the medications treatments for the disease of obesity and its related health issues.

"We don't want to see people having to wait until they have these additional diseases before they get treatment," Chiquita Brooks-LaSure, the administrator of the Centers for Medicare & Medicaid Services (CMS), told The New York Times.

Under the proposed rule, every state Medicaid program would be required to cover the cost of the medications, which currently are priced at more than $1,200 per month before any drug company discounts.

According to CMS estimates, passage of the rule would open access to the weight-loss medications to 3.4 million potential new patients under Medicare and another 4 million under Medicaid.

But the incoming Trump administration would need to sign off on the new legislation. The person tapped by the president-elect to head the Department of Health and Human Services, Robert F. Kennedy Jr., has long been a skeptic of the drugs, asserting that weight loss should instead be tackled by healthy eating.

"If we just gave good food, three meals a day, to every man, woman, and child in our country, we could solve the obesity and diabetes epidemic overnight," Kennedy told Fox News before the election. That opinion runs counter to Mehmet Oz, M.D., the former television host who is Trump's pick to head CMS. Oz, who would report to Kennedy, has been vocal in his support of GLP-1 RA medications, The Times noted.

Public support for Medicare coverage of the medications is strong: One poll from the University of Michigan revealed that 76 percent of older Americans support such a move. However, allowing eligible patients coverage for the medications would cost Medicare $25 billion over a decade and Medicaid $11 billion, Brooks-LaSure told The Times.

It is probable that the cost of Wegovy (made by Novo Nordisk) and Zepbound (made by Eli Lilly) would fall: The Biden administration has already passed legislation allowing Medicare to negotiate the price of Wegovy, starting in 2025.

The New York Times Article

Disclaimer: Statistical data in medical articles provide general trends and do not pertain to individuals. Individual factors can vary greatly. Always seek personalized medical advice for individual healthcare decisions.

Source: HealthDay

Posted : 2024-11-28 00:00

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