Several healthcare leaders are showing their support for the Biden-Harris Administration’s new proposed rule that would expand coverage of GLP-1s for those with Medicare and Medicaid.
Medicare and Medicaid currently cover GLP-1s like Ozempic and Wegovy for diabetes, but Medicare is prohibited from covering them for weight loss while only 13 state Medicaid programs do. The proposal, meanwhile, aims to cover the drugs for obesity as well. According to a White House fact sheet, the proposal could support 3.4 million Medicare enrollees and reduce out-of-pocket costs for these medications by 95% for some beneficiaries. In addition, 4 million adult Medicaid enrollees would gain access to the medications.
The Health Equity Coalition for Chronic Disease called the announcement a “major step forward.” The organization is focused on reducing barriers for communities of color when it comes to the treatment of chronic diseases.
“Communities of color are disproportionately impacted by obesity which is why we have long called on decision makers to expand Medicare and Medicaid coverage to include the full range of obesity treatment options — including greater access to intensive behavioral therapies, screenings, and anti-obesity medications,” leaders of the organization said in a statement. “Today’s action will not only help millions achieve more positive health outcomes, but will move us closer toward creating a more equitable health care system — that has for too long excluded millions facing systemic barriers in accessing the care they need and deserve.”
The Alliance for Women’s Health & Prevention (AWHP) also came out in support of the White House’s announcement but noted that the final decision now falls on the incoming Trump administration. The nonprofit is focused on women’s preventive health and leads the EveryBODY Covered campaign, which is working to expand coverage for obesity care.
“We know that obesity has a significant impact on women — particularly women of color — across every stage of life. … But insurance barriers often place the full range of obesity care options — particularly medications — out of reach for many Americans,” said Millicent Gorham, CEO of AWHP. “Now, the responsibility of ensuring comprehensive coverage of obesity care will be passed to the incoming Trump-Vance Administration, who will ultimately decide whether to enact this change. It is our sincere hope that chronic diseases like obesity are a focus of the incoming administration, and we look forward to working with them to finalize and implement this rule.”
Another advocate for coverage of GLP-1s is hopeful that the incoming administration will support this proposal but stated that there could be some opposition from Robert F. Kennedy Jr., Trump’s pick for secretary of the Department of Health and Human Services.
“RFK Jr.’s stated position has been one of lifestyle-only focused approaches to obesity treatment,” said Brooke Boyarsky Pratt, founder and CEO of knownwell, a weight care company. “We have 30 years of research to show that most Americans cannot ‘diet and exercise’ their way out of obesity long term. What Americans need is a comprehensive approach, including medical treatment, to improve chronic disease longitudinally. We hope the new administration makes a push for comprehensive, clinically-based care – which should include lifestyle factors, but also hopefully makes room for high quality clinical treatment.”
The proposed rule comes as about 42% of Americans have obesity, and these drugs are proving effective in supporting weight loss. However, without insurance coverage, the drugs can cost $1,000 a month, according to the announcement.
Photo: Jason Dean, Getty Images
