A House panel took the first step to pave the way for Medicare to cover the cost of weight loss drugs on Thursday, June 27. For more than two decades, a law has prohibited Medicare from paying for these medications.
The recent uptick in the use of these drugs – like Wegovy and Zepbound – has renewed calls for that to change.
On Thursday, the House Ways and Means Committee overwhelmingly passed a bill that would allow Medicare to cover the popular drugs. However, the new plan is significantly more restrictive than prior proposals.
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The bill is primarily targeted at making sure people currently taking weight loss drugs don’t get kicked off when they enter the Medicare program – as long as they’ve been taking them for at least a year.
The coverage would also apply only to people with obesity, not those who are overweight with at least one weight-related condition, which the FDA said is also a viable reason to prescribe these medications.
The bill would also change how intensive behavioral therapy is covered. That’s a treatment approach that offers patients counseling on nutrition and exercise but does not include weight loss drugs.
Some lawmakers are concerned over the cost of these drugs. A monthly supply of Wegovy or Zepboud can cost more than $1,000.
The Congressional Budget Office has already warned that if Medicare were to cover weight loss medications, the cost “would be significant over the next 10 years.”
Here’s some perspective: If half of the adults with obesity in America took Wegovy or another similar weight loss drug, it could cost $411 billion per year. Comparatively, Americans spent $406 billion on all retail prescription drugs in 2022, according to a report released by Sen. Bernie Sanders, I-Vt., in May.
The report also looked at the impact these drugs could have on Medicare, specifically. It said if half of all Medicare and Medicaid patients who are obese took these weight loss drugs, the programs could spend $166 billion per year. That’s nearly as much as the two programs spent on all retail prescriptions drugs in 2022 – $175 billion.
Sanders released a statement on that report saying it makes it, crystal clear that “the outrageously high price of Wegovy and other weight loss drugs have the potential to bankrupt Medicare and our entire health care system.”
The legislation will now make its way to the full House, but it’s unclear whether it can get enough votes to be passed. Even if it did, it would still need to pass the Senate and be endorsed by the president.
The current congressional session will end on Jan. 3 and any bills not signed into law by then need to be reintroduced in the next session, starting the whole process over.
Tags: Bernie Sanders, Eli Lilly, Medicaid, Medicare, prescription drugs, U.S. Food and Drug Administration, Weight Loss
A HOUSE PANEL TOOK THE FIRST STEP TO PAVE THE WAY FOR MEDICARE TO COVER THE COST OF WEIGHT LOSS DRUGS.
FOR MORE THAN TWO DECADES – A LAW HAS PROHIBITED MEDICARE FROM PAYING FOR THESE MEDICATIONS.
THE RECENT UPTICK IN THE USE OF THESE DRUGS – LIKE WEGOVY AND ZEPBOUND – HAS RENEWED CALLS FOR THAT TO CHANGE AND THURSDAY… THE HOUSE WAYS AND MEANS COMMITTEE OVERWHELMINGLY PASSED A BILL THAT WOULD ALLOW MEDICARE TO COVER THE POPULAR DRUGS.
HOWEVER – THE NEW PLAN IS SIGNIFICANTLY MORE RESTRICTIVE THAN PRIOR PROPOSALS.
IT’S PRIMARILY TARGETED AT MAKING SURE THAT PEOPLE CURRENTLY TAKING WEIGHT LOSS DRUGS DON’T GET KICKED OFF WHEN THEY ENTER THE MEDICARE PROGRAM – AS LONG AS THEY’VE BEEN TAKING THEM FOR AT LEAST A YEAR.
THE COVERAGE WOULD APPLY *ONLY* TO PEOPLE WITH OBESITY – NOT THOSE WHO ARE OVERWEIGHT WITH AT LEAST ONE WEIGHT-RELATED CONDITION… WHICH THE F-D-A SAYS IS ALSO A VIABLE REASON TO PRESCRIBE THESE MEDICATIONS.
THE BILL WOULD ALSO CHANGES HOW INTENSIVE BEHAVIORAL THERAPY IS COVERED.
THAT’S A TREATMENT APPROACH THAT OFFERS PATIENTS COUNSELING ON NUTRITION AND EXERCISE, BUT DOES NOT INCLUDE WEIGHT LOSS DRUGS.
SOME LAWMAKERS ARE CONCERNED OVER THE COST OF THESE DRUGS – A MONTHLY SUPPLY OF WEGOVY OR ZEPBOUD CAN COST MORE THAN $1,000.
THE CONGRESSIONAL BUDGET OFFICE HAS ALREADY WARNED THAT IF MEDICARE WERE TO COVER WEIGHT LOSS MEDICATIONS, THE COST “WOULD BE SIGNIFICANT OVER THE NEXT 10 YEARS.”
HERE’S SOME PERSPECTIVE: IF HALF OF THE ADULTS WITH OBESITY IN AMERICA TOOK WEGOVY OR ANOTHER SIMILAR WEIGHT LOSS DRUG – IT COULD COST 411 *BILLION* DOLLARS PER YEAR
COMPARATIVELY… AMERICANS SPENT 406 BILLION ON *ALL* RETAIL PRESCRIPTION DRUGS IN 20-22, ACCORDING TO A REPORT RELEASED BY SENATOR BERNIE SANDERS LAST MONTH.
THE REPORT ALSO LOOKED AT THE IMPACT THESE DRUGS COULD HAVE ON MEDICARE, SPECIFICALLY.
IT SAID IF HALF OF ALL MEDICARE AND MEDICAID PATIENTS WHO ARE OBESE TOOK THESE WEIGHT LOSS DRUGS… MEDICARE AND MEDICAID COULD SPEND 166 BILLION DOLLARS PER YEAR.
THAT’S NEARLY AS MUCH AS THE TWO PROGRAMS SPENT ON ALL RETAIL PRESCRIPTIONS DRUGS IN 20-22 – 175 BILLION.
SENATOR SANDERS RELEASED A STATEMENT ON THAT REPORT SAYING IT MAKES IT CRYSTAL CLEAR THAT “THE OUTRAGEOUSLY HIGH PRICE OF WEGOVY AND OTHER WEIGHT LOSS DRUGS HAVE THE POTENTIAL TO BANKRUPT MEDICARE AND OUR ENTIRE HEALTH CARE SYSTEM.”
THE LEGISLATION WILL NOW MAKE ITS WAY TO THE FULL HOUSE – BUT IT’S UNCLEAR WHETHER IT CAN GET ENOUGH VOTES TO BE PASSED.
AND EVEN IF IT DID – IT WOULD STILL NEED TO PASS THE SENATE AND BE ENDORSED BY THE PRESIDENT.
AND TIME IS RUNNING OUT.
THE CURRENT CONGRESSIONAL SESSION WILL END ON JANUARY 3-RD AND ANY BILLS NOT SIGNED INTO LAW BY THEN NEED TO BE REINTRODUCED IN THE NEXT SESSION – STARTING THE WHOLE PROCESS OVER.
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