Medicare Weight Loss Drug Coverage Advances Amid Fiscal And Access Concerns

For more than two decades, a law has prohibited Medicare from paying for weight loss drugs, cutting off access to millions of potential patients who could stand to benefit. This ban has become more apparent with the approval of expensive drugs such as Wegovy and Zepbound by the Food and Drug Administration, which are financially out of reach for many without insurance coverage, NBC News reports.

On Thursday, the House Ways and Means Committee advanced legislation known as The Treat and Reduce Obesity Act of 2023, marking a significant step towards overturning this prohibition, according to Becker's Healthcare. The bill proposes to allow Medicare coverage for weight loss medications under certain conditions, such as individuals being prescribed the drugs for at least one year before transitioning to Medicare.

This legislative move follows years of congressional gridlock on similar bills, with earlier attempts failing to gain momentum until now. The proposal aims to strike a balance between expanding access to critical treatments and managing potential financial impacts for Medicare, a concern highlighted by the Congressional Budget Office's warnings about significant costs over the next decade.

Chair Rep. Jason Smith introduced an amendment to narrow coverage to individuals with obesity, a compromise compared to broader coverage initially proposed in previous versions of the bill. The amendment underscores ongoing debates in Congress about healthcare spending priorities and the sustainability of Medicare funding.

Despite advancing through the Ways and Means Committee, the bill's future remains uncertain, pending approval from the full House, Senate, and presidential endorsement before the legislative session concludes in early 2025. Efforts led by Sen. Bernie Sanders to address drug pricing issues, including the high cost of medications like Wegovy, continue to draw public attention and scrutiny.