Trump’s administration on Friday rejected a Biden plan that would require Medicare and Medicaid to cover obesity drugs and expand access to millions of people.
According to the law that introduced the benefits of the Medicare Drug, the program was banned from paying for “weight loss” drugs. However, the Biden administration’s proposal last November attempted to bypass the ban by arguing that medicines could deal with the disease of obesity and its relative conditions.
Extension of drug coverage will cost the federal government billions of dollars. The Congress Budget Office estimates that federal expenses would amount to about $ 35 billion for 10 years.
The decision he announced on Friday was part of a larger 438 -page regulation that informed parts of Medicare Drug and Medicare Advantage, private insurance plans now used by about half of Medicare.
Catherine Howden, a representative of the Medicare and Medicaid services centers, said in an email that the organization believed that the expansionist coverage “is not appropriate at the moment”. But he said that the organization had not excluded coverage and “can consider future policy options”.
Medicare, the government’s insurance plan for Americans over 65 and people with disabilities, covers weight loss medications for patients with diabetes and a much smaller subset of people who are obese and also have heart problems or sleep apnea.
Biden’s plan would have expanded to cover to patients who were obese but did not have these diseases. Medicare officials had estimated that about 3.4 million more people would choose to take drugs under politics.
The most popular weight loss drugs are manufactured by Novo Nordisk, which sells his medicine as a Wegovy for obesity and as an ozempic for diabetes and from Eli Lilly, who sells his product as a Zepbound for obesity and Mounjaro for diabetes.
Eli Lilly and Novo Nordisk are now offering their products for $ 350 to $ 500 per month to patients who pay their own money instead of going through insurance. But until recently, patients sometimes pay more than $ 1,300 a month.
Robert F. Kennedy Jr., the Health Secretary, has shouted in his criticism of weight loss medications, saying he is inferior to eating healthy foods.
Medicines have been proven in clinical trials to benefit well beyond weight loss, such as preventing heart attacks and strokes.
Supporters of extensive coverage argued that the government’s spending on drugs would pay at least in part to themselves in the long run. Patients, they say, will become healthier and this would prevent expensive medical accounts. It is not yet clear whether such savings will be implemented.
Medicaid state programs, which provide health care for the poor, can currently choose whether to cover drugs and some do. If Biden’s wider policy had been finalized, cover would be necessary in every state.
Obesity medicines cost Medicare and Medicaid hundreds of dollars per patient each month, although the exact prices are secret.
Many employers and private health insurance plans do not cover drugs. Some, including government plans for employees in North Carolina and western Virginia, threw drug coverage after increasing their popularity, reporting high costs.
Without insurance coverage, many patients in Medicare and Medicaid are based on cheap versions of copy of the drugs produced through a drug mixing process known as a complex. These versions, which are allowed because branded medicines were incomplete, can cost less than $ 200 a month. However, regulators have ordered such sales to end soon, as the offer of branded names has improved.
Republicans in Congress expressed some interest in the Medicare demand to cover the drugs. The idea was included in a list of policy options produced by the House Budget Committee earlier this year. But it does not seem to be an important priority right now.
In an attempt to reduce costs, Medicare opted for Novo Nordisk Wegovy for negotiations to reduce prices under a law passed by a democratic controlled conference in 2022.
