WASHINGTON — The Biden administration has proposed a \$35 billion plan to expand access to popular weekly weight-loss injections for millions of obese Americans through Medicare and Medicaid. However, it is unclear whether the incoming Trump administration will support the rule.
The new policy, revealed Tuesday by the Department of Health and Human Services (HHS), would require Medicare and Medicaid to cover drugs like Wegovy and Zepbound, which help patients lose weight by regulating appetite. These medications mimic the hormone glucagon-like peptide 1 (GLP-1), which signals fullness between the gut and brain.
Clinical trials show that most patients using these drugs lost between 15% and 22% of their body weight, sometimes more than 50 pounds. However, some people did not see significant results. Currently, private insurers limit coverage, and Medicare is barred by law from covering weight-loss drugs. Medicaid coverage varies by state. The drugs can cost over \$1,000 per month, making them unaffordable for many.
The proposal targets roughly 70 million Medicaid recipients and 67 million Medicare beneficiaries. The Centers for Medicare and Medicaid Services (CMS) estimates that up to 3.5 million Medicare and 4 million Medicaid beneficiaries could qualify for the drugs. However, about 28 million people on Medicaid are classified as obese. The government predicts the plan will cost at least \$35 billion over the next decade.
Support for the proposal is uncertain under the new administration. President-elect Trump’s choice for HHS head, Robert F. Kennedy Jr., opposes expanding coverage for these drugs, advocating instead for more government support for healthy foods and gym memberships. On the other hand, Dr. Mehmet Oz, expected to lead CMS, has acknowledged the drugs’ benefits but calls for further research on long-term effects.
Some lawmakers have welcomed the move. Republican Rep. Brad Wenstrup, who has pushed for Medicare coverage of weight-loss drugs, said the proposal could save taxpayers money in the long run. He also called for funding to support dietitians and behavioral therapy. Meanwhile, Sen. Bernie Sanders cautioned that without lowering drug prices, Medicare premiums could rise sharply.
Doctors agree the drugs can be effective but urge caution. Harvard nutrition expert Dr. David Ludwig hopes the medications will not become the main approach to treating obesity. He emphasizes the need to address underlying causes like diet and exercise, noting the drugs have side effects. Dr. Andrew Kraftson of the University of Michigan, who has prescribed these drugs successfully, also stresses careful use, especially for older patients. He notes that the drugs may cause muscle loss, which is dangerous for seniors at risk of falls, and calls for clearer guidelines on prescribing.
As the rule awaits final approval, questions remain about whether it will be implemented and how the government will balance expanding access with concerns over cost, safety, and long-term obesity treatment strategies.
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