Trump Administration Blocks Biden’s Plan for Medicare and Medicaid to Fund Anti-Obesity Medications

The Trump administration recently decided not to proceed with a plan from the Biden era aimed at expanding access to expensive anti-obesity medications for over 7 million Americans on Medicare and Medicaid. This proposal was first introduced in November, but the Centers for Medicare and Medicaid Services (CMS) chose to leave it behind without offering detailed reasons.

In a statement, CMS did mention that future options for anti-obesity medications could still be on the table. They plan to look at the potential benefits of these drugs and their costs, particularly how they might impact state Medicaid agencies.

It’s worth noting that Robert F. Kennedy Jr., the new Secretary of Health and Human Services, has had a critical view of these medications. In contrast, Dr. Mehmet Oz, the recently appointed administrator at CMS, has promoted them during his TV shows and on social media. The administration’s focus on cutting federal spending also played a role in this decision.

The withdrawn proposal could have provided access to these anti-obesity treatments for around 3.4 million Medicare and 4 million Medicaid recipients. Currently, 22% of Medicare enrollees have been diagnosed with obesity, a figure that’s more than doubled in the past decade. While Medicare does not traditionally cover weight-loss drugs, the Biden administration aimed to categorize obesity as a chronic disease to allow for this coverage.

As it stands, only 13 states currently cover GLP-1 medications for obesity, according to KFF, a nonprofit health policy organization. The potential costs of expanding these health services were significant: an estimated $25 billion over ten years for Medicare and an additional $11 billion for Medicaid, along with $3.8 billion for individual states. Many state Medicaid agencies raised concerns about these financial implications.

Despite the halt in expansion, experts like Rachel Sachs, a law professor at Washington University, note that more beneficiaries are starting to get coverage for these medications. This is happening because the drugs are gaining approval for treating additional health issues, including heart disease and sleep apnea.

However, the high costs of these medications remain a barrier for many. For instance, Wegovy can cost nearly $1,350 for just a four-week supply, although discounts are available. Zepbound also comes at a steep price but has some starter doses offered at a lower rate.

Healthcare policy experts express concern about the status quo. “People on Medicare who need these drugs are left to pay out of pocket,” says Juliette Cubanski from KFF. For many seniors, the steep prices make access unfeasible.

The ongoing discussion around obesity treatment access and cost reflects broader trends in healthcare, where policy changes can significantly impact a large portion of the population. As this debate continues, it will be crucial to monitor how state-level decisions and drug developments may alter the landscape for those struggling with obesity.

For further information on health policy trends, you can visit KFF, a leading source for health data and insights.

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