On Friday, the Trump administration rejected the Biden plan, which called for Medicare and Medicaid to cover obesity drugs and demanded greater access to millions of people.
Under the law that established part of Medicare's drug benefits, the program was barred from paying for drugs for “loss weight.” However, last November, the Biden administration's proposal tried to avoid that ban by claiming that drugs would be allowed to treat obese diseases and their related conditions.
Expanding drug coverage costs the federal government billions of dollars. The Congressional Budget Office estimated federal government costs around $35 billion over a decade.
The decision announced Friday is part of a 438-page regulation that updates some of Medicare's part D drug benefits and some of the benefits of Medicare, a private insurance plan currently being used by about half of Medicare beneficiaries.
Catherine Howden, a spokesman for the Centers for Medicare and Medicaid Services, said in an email that the agency believes it is “not appropriate at this time.” However, she said the agency would eliminate drug compensation and “may consider future policy options.”
Medicare is a government insurance program for Americans and disabled people over the age of 65, covering a much smaller subset of weight loss medications for diabetics and those with obesity who have heart problems and sleep apnea.
The Biden plan would have extended coverage for patients who were obese but did not have those diseases. Medicare officials estimated that around 3.4 million people had chosen to take drugs under the policy.
The most popular weight loss pills are made by Eli Lilly, who sells the drug as Wegovy for obesity and sells its products as Diabetes Ozempic and Diabetes Obesity Zepbound and Munjaro.
Eli Lilly and Novo Nordisk offer products ranging from $350 to $500 a month to patients who pay with their own money rather than incurring them. However, until recently, patients paid more than $1,300 a month.
Health Secretary Robert F. Kennedy Jr. has spoken out in his criticism of weight loss pills, saying he is inferior to taking healthy foods.
Clinical trials have shown that the drug can benefit well beyond weight loss, including preventing heart attacks and strokes.
Proponents of the expanded compensation argued that government spending on drugs would pay itself at least in the long run. They say patients will become healthier, which will hinder expensive medical costs. It is not yet clear whether such savings will come to fruition.
The state's Medicaid program, which provides healthcare to the poor, can now choose whether to cover drugs or not. If the broader Biden policy had been established, all states would have needed compensation.
The exact price is a secret, but obesity drugs cost several hundred dollars per patient each month for Medicare and Medicaid.
Many employers and private health insurance plans do not cover drugs. Some people, including the state employee benefits plans in North Carolina and West Virginia, citing high costs, have dropped their drug coverage after a surge in popularity.
Without insurance coverage, many Medicare and Medicaid patients rely on inexpensive mimic versions of drugs produced through a mixed process of drug instruction known as formulation. These versions cost less than $200 a month because they were allowed due to a lack of drugs from the brand. However, regulators ordered such sales to be terminated soon as the supply of branded products has improved.
Congressional Republicans have expressed some interest in demanding Medicare to cover drugs. The idea was included in a list of policy options created by the House Budget Committee earlier this year. But that doesn't seem to be a major priority for now.
To cut costs, Medicare has chosen Novo Nordisk's Wegovy for negotiations to lower prices under a 2022 law passed by a Democratic-controlled Congress. These low prices start in 2027 for eligible people.
