Biden wants to expand access to Ozempic and other popular weight loss drugs
President Joe Biden is trying to expand access to pricey blockbuster drugs in his final months in office.
The Biden-Harris administration proposed a new rule on Tuesday that would expand coverage of the anti-obesity medications known as GLP-1 treatments for Medicare and Medicaid beneficiaries. Medicare is currently only allowed to cover these medications for weight loss if they are prescribed to treat a second condition as well.
GLP-1s are a class of drugs made popular by Novo Nordisk’s diabetes treatment Ozempic. The treatments mimic a hormone that regulates appetite and blood sugar and have become highly sought after as treatments for obesity and Type 2 diabetes.
Insurance coverage for GLP-1 drugs for the specific use of weight loss can vary widely by plan. Some insurance companies and employers have been hesitant to cover the treatments due to their high costs.
“Over the past few years, there have been major scientific advancements in the treatment of obesity, with the introduction of new life-saving drugs,” the White House said in a press release. “But for too many Americans, these critical treatments are too expensive and therefore out of reach.”
Without insurance, Novo Nordisk’s (NVO) weight-loss drug Wegovy costs $1,349.02 for a one-month supply, while its competitor Eli Lilly (LLY) prices most doses of its competiting drug Zepbound at $1,059.87 per month.
The proposed rule would expand coverage of theese drugs to an estimated 3.4 million Americans with Medicare and about 4 million adult Medicaid enrollees. It could also help slash out-of-pocket costs for these drugs by as much as 95 percent for some enrollees.
The proposal must still undergo a formal rule-making process, which could take several months, and would require endorsement from President-elect Donald Trump to be implemented.
Data shows that government-funded health insurance plans in the United States already provide the majority of coverage for these popular weight-loss drugs.
Only about 65 million, or 25%, of Americans have a health insurance plan that covers these weight-loss drugs, according to data from consulting firm Leverage. The firm’s AXIACI Obesity Coverage Nexus database tracks the insurance coverage of weight-loss treatments of roughly 80% of Americans.
The majority of GLP-1 weight-loss drug coverage comes from state Medicaid plans. Leverage estimates that Medicaid plans, which are government programs for low-income families, provide weight-loss drug coverage for 31.6 million people.
Additionally, 20.6 million federal, state, and local government employees and their families have plans with weight-loss drug coverage. Together, these government-funded plans make up about 80%, or 52.2 million, of the Americans with weight-loss drug coverage.
Private or employer-sponsored plans, meanwhile, provide GLP-1 weight-loss drug coverage for 13.7 million people, according to the database. But because many employers don’t make the details of their plans public, Leverage estimates this number could be up to 24.4 million people.
