Biden Administration Launches Initiative to Include Weight Loss Medications in Medicare and Medicaid

The Biden administration has announced a significant policy shift regarding access to anti-obesity medications for Medicare and Medicaid patients. This reinterpretation aims to enhance long-term weight management for individuals affected by obesity.

The proposed rule by the Centers for Medicare and Medicaid Services (CMS) comes with an estimated cost of $25 billion for Medicare and an additional $14.8 billion for Medicaid over the next decade. The figures reflect expected federal and state spending, highlighting the financial implications of the new policy.

CMS is actively seeking input from states on how they can implement the Medicaid provisions of the rule, recognizing that Medicaid involves a shared financial responsibility between federal and state governments.

Medicare primarily serves individuals aged 65 and older, as well as some younger individuals with certain disabilities. Medicaid caters to low-income individuals, ensuring they have access to necessary healthcare services.

“People with obesity deserve affordable access to medical treatments, including anti-obesity medications,” said CMS Administrator Chiquita Brooks-LaSure. This perspective is rooted in the recognition of obesity as a chronic condition that requires comprehensive management.

Brooks-LaSure emphasized that the reinterpretation aligns with current medical consensus, viewing obesity not merely as a lifestyle issue but as a serious health condition that can contribute to other critical health problems, including heart disease and diabetes.

Statistics reveal that more than 40% of Americans experience obesity, with 22% of Medicare recipients diagnosed with the condition in 2022—a figure that has reportedly doubled over the last decade.

In a fact sheet, CMS noted that prior interpretations of federal law excluded weight-loss drugs from coverage, limiting beneficiaries’ access to treatments. This change represents a historic shift in policy aimed at combatting obesity through medical support.

Responses to the proposed rule varied. While President-elect Donald Trump had not commented by Tuesday morning, prospective HHS Secretary Robert F. Kennedy Jr. has voiced skepticism regarding newer weight loss medications. During a recent Fox News appearance, Kennedy suggested that providing healthy meals could be a more effective strategy than pharmaceutical intervention.

Under the proposed changes, an estimated 3.4 million Medicare beneficiaries could qualify for coverage of anti-obesity medications if the rule is finalized by Trump’s administration by 2026.

CMS Deputy Administrator Dan Tsai expressed the hope that states would share insights on the implementation timeline and the broad implications of this reinterpretation, reinforcing the collaborative effort required to improve healthcare access.

Interestingly, the Congressional Budget Office (CBO) projected a slightly different cost for the program, estimating $35 billion in federal spending from 2026 to 2034 for anti-obesity medications. The CBO also stated that the overall health savings from improved beneficiary health would be modest compared to direct medication costs.

Currently, Medicare does cover certain obesity-related services, such as screening and behavioral counseling. However, medications for general weight management fall outside the scope of standard prescription drug benefits, complicating the landscape of obesity treatment under federal programs.

The CBO report pointed out that while other programs are optional, nine states have included coverage for drugs like Wegovy in their Medicaid programs as of early 2023. Responses from state healthcare associations remain pending as they assess the potential impacts of the proposed rule.