Introduction
The outgoing president Joe Biden has taken a big step in healthcare support by proposing Medicare and Medicaid courage for weight loss medications. His administration has proposed a new law that would expand the coverage to anti-obesity drugs. This modification in the rule may change the expensive obesity drugs into affordable weight loss drugs. Many of these drugs are related to GLP-1 weight-loss medications, such as Wegovy and Ozempic.
News in Detail
Currently, Medicare coverage for weight loss drugs is only possible if they are used to treat chronic conditions, including heart diseases and diabetes. States are allowed to cover GLP-1 weight loss medications under Medicaid, but most of them have decided against this option.
Under the proposed rule, the federal government is interpreting the law by declaring GLP-1 weight-loss medications as a method to treat chronic conditions instead of classifying them as weight-loss treatments. The CMS administrator further clarifies these points by arguing that the medical community now considers obesity a chronic disease due to its long-term negative impacts on human health. Therefore, GLP-1 medications for weight loss can bring revolutionary changes by preventing or treating chronic diseases caused by unnecessary weight gain.
Anti-Obesity Drugs Cost
The anti-obesity drugs are quite expensive and generally cost over $1000 per month. However, their coverage will dramatically reduce their expenses for users, comprising 3.4 million enrollees in Medicare and an additional 4 million related to Medicaid. The federal government will bear the majority of the cost in the next decade. It is estimated to be $36 billion for the federal government ($25 billion for Medicare and $11 billion for Medicaid). The share of states is around $3.8 billion. The government expects that out-of-pocket premiums will not increase for beneficiaries despite an increase in GLP-1 weight-loss coverage.
Timeline
The proposal will come into effect after 60 days of public comment period. It means the current regime will not be able to finalize this coverage, and it depends on the policies of the new government. There are mixed messages on this rule by the proposed officials of the new administration. Due to differences in the opinions about this matter, the final decision will likely be taken by the White House. Experts believe the new government will not oppose this rule because it affects millions of Americans.
Otherwise, it will negatively affect the reputation of the regime among common Americans who rely on Medicare and Medicaid to cover their necessary health costs. Drugs like Wegovy and Ozempic Medicare coverage can assist them in reducing the severity of chronic conditions by eliminating obesity, one of the primary risk factors of these diseases.
Despite the popularity of such steps, there is opposition from various corners. According to a report, less than 20% of large corporations in the country provide insurance for anti-obesity drugs due to their higher costs. Some experts also believe that the majority contribution by the federal government can bankrupt it due to the higher costs of these drugs and the increase in the obese American population. Therefore, it will ultimately result in an increase in Medicare premiums for all members of these services, whether they use these drugs or not. Visit Benefits by State for more insights.