A recent proposal from the Biden administration aims to enable millions of Americans suffering from obesity to receive coverage for popular weight-loss medications such as Wegovy and Ozempic through Medicare and Medicaid. The initiative, introduced by the U.S. Department of Health and Human Services, could face opposition from the pharmaceutical industry and figures such as Robert F. Kennedy Jr. This proposal could impose a financial burden on taxpayers, potentially amounting to $35 billion over the next ten years.

U.S. Health and Human Services Secretary Xavier Becerra expressed optimism about the proposal, describing it as a significant advancement for individuals battling obesity who previously could not afford these medications. The White House emphasized that this change would empower Americans to pursue healthier lifestyles without the financial constraints of out-of-pocket expenses, ultimately aiming to reduce overall healthcare costs.

According to the proposal, individuals prescribed these drugs for long-term weight management will be eligible for coverage through Medicare and Medicaid. Many current Medicare beneficiaries may already qualify based on associated health issues like diabetes or heart disease, while an additional 7% could gain new eligibility through this initiative. In state Medicaid programs, the coverage would now include those who are obese, promoting wider access to these therapies.

The weight-loss drug market has seen considerable growth, with FDA approvals for several weekly injectables designed to aid in obesity treatment. These medications can enable weight loss ranging from 15% to 25% of body weight by mimicking hormones that regulate appetite. Nevertheless, high costs have previously restricted access to affluent individuals, as Wegovy and Zepbound can cost over $1,000 monthly, compounded by supply shortages.

If approved, Medicare would expand coverage for these medications in 2026, with the proposal not expected to affect senior premiums significantly in the short term. Public comments are being sought regarding timing for the implementation in state Medicaid programs, as officials emphasize the need to balance access to these drugs with state budget considerations.

The future of this coverage proposal remains uncertain, particularly if it faces opposition from Trump administration allies, who may be concerned about the associated costs. Traditionally, Medicare has been restricted from covering weight-loss medications, but this new rule would classify obesity as a treatable disease, reflecting a shift in policy focus. Kennedy has openly criticized the prevalence of these drugs, advocating instead for greater access to healthier foods and fitness options as a more cost-effective solution for combating obesity.