Congress Considers Expanding Medicare Coverage for Prescription Weight Loss Medications
By: Jessie Bekker, Burr & Forman LLP
Some Congressional leaders voted to expand Medicare coverage for prescription medications to treat obesity.
The House of Representatives Ways and Means Committee voted in late June to pass the Treat and Reduce Obesity Act of 2023. If passed, the bill would approve Medicare Part D coverage for glucagon-like peptide-1 agonists, or GLP-1 agonists, including semaglutide, a diabetes medication.
The medications, also approved by the Food and Drug Administration (FDA) for the treatment of cardiovascular disease, have gained popularity under name brands including Wegovy and Ozempic for their promotion of weight loss.
The Treat and Reduce Obesity Act of 2023 would allow Medicare Part D to cover obesity treatment medications for those who also present with at least one comorbidity. The Act would also expand Medicare coverage for intensive behavioral therapy related to obesity when provided upon referral from primary care providers by other physician specialists and health care providers, including nurse practitioners, physician assistants, registered dietitians and clinical psychologists. (Medicare currently only provides coverage for obesity-related intensive behavioral therapy provided by primary care practitioners).
A version of the bill was introduced in the Senate in 2023 and referred to the Committee on Finance.
The bill has received bipartisan support, but it is not the first time Congress has considered the measure. In 2021, Congress considered a bill by the same name in both the House and Senate, but it gained little traction.
According to the Congressional Budget Office (CBO), which assesses the estimated economic impact of proposed legislation, “the evidence suggests that the amount of potential savings on cardiac care and other health care would be less than the current net federal cost of [anti-obesity medication],” basing its determination on the current costs of those medications against spending on treatment of common conditions associated with obesity, like cardiovascular disease. The CBO attributed the net economic loss to the high cost of anti-obesity medications and comparatively small decrease in health care spending by people who lost weight and experienced health benefits. The CBO further noted that it expected Medicare cost-sharing and premiums to increase in the event of coverage for anti-obesity medications.
Concurrently, Medicare Advantage providers are contemplating coverage for anti-obesity medications. In statements to Modern Healthcare, Kaiser Permanente’s Kaiser Health Plan and CVS Health’s Aetna reported that each would begin providing coverage for brand name Wegovy to their enrollees.
The CBO reported that U.S. net sales of Ozempic, Wegovy, and Rybelsus, an oral version of Ozempic versus its injectable counterpart, totaled $3.4 billion in the second quarter of 2023, while U.S. net sales of all glucagon-like peptide-1 agonists in that time period totaled $5.9 billion. Meanwhile, FDA reports show demand for semaglutide injections have driven shortages of the drugs.
Jessie Bekker is an attorney at Burr & Forman LLP practicing exclusively in the firm’s healthcare practice group. Jessie can be reached at jbekker@burr.com or (205) 458-5275.
