Biden administration proposes Medicare coverage for weight loss drugs: 10 things to know

The White House is pitching broader coverage of weight loss drugs for millions of Americans on Medicare and Medicaid.

The proposal would expand coverage for weight loss drugs to an estimated 3.4 million Medicare beneficiaries, according to a Nov. 26 news release. 

Here are 10 things to know about the proposal: 

1. Currently, Medicare only covers weight loss drugs to treat diabetes or other conditions. A handful of state Medicaid programs already choose to pay for weight loss drugs. 
   
   
2. GLP-1s, including Wegovy and Ozempic, can cost over $1,000 a month without insurance coverage. 
   
   
3. Medicare coverage of the drugs could cost the federal government $35 billion by 2034, according to estimates published by the Congressional Budget Office in October. CBO estimates the cost of the drugs will decline over time.
   
   
4. Research published by the Blue Cross Blue Shield Association in May found that 58% of patients discontinue the use of GLP-1s before seeing clinically meaningful health benefits.
   
   
5. Earlier this year, the House Ways and Means Committee advanced a proposal to allow Medicare coverage of GLP-1s for beneficiaries who had the drug prescribed  for at least a year before switching to Medicare.
   
   
6. In May, Sen. Bernie Sanders, chair of the Senate committee on Health, Education, Labor and Pensions, warned GLP-1s could bankrupt the U.S. healthcare system.
   
   
7. With just weeks remaining for the Biden administration, the move could put pressure on the incoming Trump administration to approve coverage of weight loss drugs under Medicare, The New York Times reported Nov. 26.
   
   
8. Robert F. Kennedy Jr., Trump's nominee for HHS secretary, has advocated for a nutrition-based approach to treating obesity over medications, according to the Times. Mehmet Oz, MD, Trump's pick for CMS Administrator, has promoted weight loss drugs on his television program.
   
   
9. Insurance coverage for GLP-1s is broadly popular, according to a survey from KFF published in August 2023. Four in 5 adults say insurers should cover the drug for adults diagnosed as overweight or obese.
   
   
10. Employer-sponsored coverage of weight-loss drugs varies. Around 44% of large employers cover weight-loss drugs for obesity, according to a survey by Mercer published Nov. 20. Medicare coverage could open the door to broader coverage by private insurers and self-funded plans.