In a policy shift, the Trump administration blocked Biden’s proposed expansion for Medicare and Medicaid, leaving the fate of obesity medication coverage hanging in balance.
Quick Takes
- The Trump administration revoked a Biden-era plan for obesity medication coverage under Medicare and Medicaid.
- Medicare has banned weight loss drug coverage for over two decades.
- The abandoned plan would have cost Medicare $25 billion and Medicaid $11 billion over ten years.
- The decision could be revisited if drug prices fall significantly.
Trump Administration Blocks Expanded Coverage
The Trump administration recently overturned a Biden-era proposal to extend Medicare and Medicaid coverage to include obesity medications, effectively halting an initiative aimed at lifting a longstanding ban on using Medicare funds for weight-loss drugs. This move underscores the persistent financial concerns surrounding GLP-1 drugs, known for their high price, raising doubts about the potential impact on Medicare premiums.
Medicare has prohibited coverage of weight loss drugs for over two decades. In November 2024, the Biden administration proposed a rule to allow Medicare Part D to include these drugs. The plan also sought to mandate Medicaid coverage, which currently exists in only 13 states. Despite potential future reconsideration if drug prices decrease, the Trump administration’s decision delays any immediate changes. Meanwhile, Congressional efforts like the Treat and Reduce Obesity Act (TROA) remain ongoing.
Financial Implications at the Forefront
The financial implications of expanding coverage for obesity medications are substantial. CMS estimated that lifting the Medicare and Medicaid bans would result in $25 billion for Medicare and $11 billion for Medicaid over a decade. Concerns about increasing Medicare Part D premiums due to the added cost burden present a significant hurdle. The Treat and Reduce Obesity Act, despite bipartisan support, has struggled to advance due to these anticipated expenses. Current list prices for drugs such as Wegovy and Zepbound exceed $1,000 monthly, with limited reimbursement options available.
Both the Biden administration and TROA advocates have labeled obesity as a chronic disease with serious health risks, thereby justifying the need for weight-loss drug coverage. Pharmaceutical companies like Eli Lilly and Novo Nordisk offer patient assistance programs and reduced-cost options, although not for Medicare or Medicaid recipients. Budget constraints strongly suggest that restrictions on coverage of obesity medications will remain, with the debate reflecting broader tensions between expanding access and sustainable healthcare spending.
The Future of Coverage Policies
The Trump administration’s decision to overturn Biden’s proposal has left the future of obesity medication coverage uncertain. The potential re-evaluation of this decision hinges on drug price adjustments and continued pressure from legislative efforts like the Treat and Reduce Obesity Act. Budgetary concerns continue to pose challenges, emphasizing the need for a balanced approach that considers both public health benefits and economic viability. As the debate continues, the conflict between expanding healthcare access and budget sustainability remains unresolved.
Sources
1. Trump Administration Nixes Plan To Allow Medicare To Cover Obesity Drugs
2. Trump administration drops Biden’s proposal of Medicare weight-loss drug coverage
