Trump Blocks Medicare Obesity Drug Coverage

Amid budget concerns, a Biden-era effort to expand Medicare and Medicaid’s coverage to include obesity medication faces opposition from the Trump administration, sparking a complex debate.

Key Takeaways

The Trump administration revoked a Biden-era plan to lift the prohibition on Medicare coverage of obesity medicines and expand access in Medicaid.
Medicare has prohibited coverage of weight loss drugs for over two decades.
The Trump administration’s decision leaves open the possibility of future reconsideration if drug prices decrease.
The Biden administration’s proposal could have made 7.4 million beneficiaries eligible, increasing costs significantly.
The Treat and Reduce Obesity Act (TROA) has bipartisan support but has stalled due to potential cost increases.

Debate Over Medicare Coverage

The Trump administration recently reversed a policy set by the Biden administration that was poised to allow Medicare and Medicaid to cover certain obesity medications. The policy aimed to eliminate a long-standing restriction on weight loss drug coverage under Medicare. This reversal reignites debates about the necessity and financial implications of providing such coverage across government healthcare programs. Concerns about the potential spike in healthcare costs remain a focal point in the discussions.

Since the prohibition on obesity medication coverage in Medicare has existed for over two decades, the Biden administration’s proposal represented a significant shift in policy direction. The proposal sought to integrate obesity drugs into Medicare Part D and mandate Medicaid coverage, which presently is only available in 13 states. The Trump administration’s pivot serves as a reminder of the enduring fiscal hurdles that must be addressed for such expansions to be realized.

Budgetary Concerns

Concerns regarding rising premiums for Medicare Part D are at the forefront of the opposition to lifting the prohibition. Centers for Medicare & Medicaid Services (CMS) estimated that the policy change could result in 7.4 million Medicare and Medicaid beneficiaries becoming eligible for coverage, costing Medicare $25 billion and Medicaid $11 billion over a decade. These figures have raised alarms about affordability and the broader impacts on healthcare budgets.

Affordability is a significant barrier, with current drug prices for obesity medications such as Wegovy and Zepbound exceeding $1,000 monthly. This price tag renders these medications inaccessible for many, despite some pharmaceutical companies offering assistance programs. However, these programs do not extend to Medicare or Medicaid patients, exacerbating the issue of unequal access and benefits among different populations.

Legislative Efforts and Challenges

This Treat and Reduce Obesity Act aims to lift the Medicare ban on obesity drug coverage, although it would not extend to Medicaid. Despite enjoying bipartisan support, TROA has not advanced, primarily due to the substantial cost implications and the consequent hesitance to strain budgets.

The Biden administration and supporters of TROA continue to argue for an expanded view of obesity as a chronic disease that poses significant health risks, necessitating aggressive treatment measures, however, the budget constraints and economic realities suggest that significant barriers to public-sector coverage will persist unless new solutions to drug pricing or funding are found. The debate continues as stakeholders seek a balance between health needs and fiscal responsibility.