Trump administration halts Medicare and Medicaid from providing coverage for anti-obesity medication at this time.
Trump's peeps just announced the ex-admin ain't goin' forward with Biden's plan to extend coverage of those pricey anti-obesity meds to over 7 mil folks on Medicare or Medicaid.
The Centers for Medicaid and Medicare Services didn't clue us in why they're holding back on finalizing the proposal. But they did say they might consider future policies for anti-obesity meds, takin' into account the drugs' benefits and costs on key players like state Medicaid agencies.
New Health and Human Services Sec'y, Robert F. Kennedy Jr., ain't a fan of these meds, while Dr. Mehmet Oz, CMS' new administrator, has hyped 'em on his TV show and social media. But the coverage expansion would've cost a pretty penny, and the Trump admin and Elon Musk's DoGE are all about slashin' the federal budget.
Under the rule, around 3.4 mil Medicare beneficiaries and 4 mil Medicaid recipients could've scored access to these meds, said the Biden crew back then. Law that governs Medicare strictly says no to drugs used for weight loss. The Biden admin proposed thinkin' different by recognizin' obesity as a chronic disease.
Currently, 13 states cover GLP-1 medications for obesity treatment, says KFF, a nonprofit health policy research organization. The federal expansion would've cost Medicare an estimated $25 bil over a decade, and the feds would drop $11 bil and states 'bout $4 bil over the same timeframe. State Medicaid agencies expressed serious concerns over the proposal's potential costs, said the National Association of Medicaid Directors.
Although the Trump admin dropped the proposal, more Medicare and Medicaid beneficiaries are grabbin' these drugs thanks to their approval for other conditions like heart disease and sleep apnea. But manyfolks are still left out—Wegovy's list price is nearly $1,350 for a month's supply, while Eli Lilly's Zepbound costs over $1,000, but the company offers starter doses at a lower price. Juliette Cubanski, deputy director of KFF's Program on Medicare Policy, notes that for many Medicare peeps, this cost might be too high for affordability.
- Robert F. Kennedy Jr., the new Health and Human Services Sec'y, shares similar sentiments with Trump's administration regarding the prohibitive costs of Medicare's coverage expansion for anti-obesity meds, as the federal budget-focused Trump administration and Elon Musk's Dogecoin might view such an expansion as unattainable.
- The potential costs of the proposed Medicare and Medicaid expansion for anti-obesity meds, estimated at around $25 billion for Medicare and $4 billion for state Medicaid agencies over a decade, have raised serious concerns, leading state Medicaid agencies to express reservations over the National Association of Medicaid Directors.
- Despite the Trump administration backing down on finalizing the proposal for Medicare and Medicaid to cover anti-obesity meds, the high cost of these drugs continues to impact access for many beneficiaries, with Wegovy's list price alone reaching nearly $1,350 for a month's supply, posing a significant challenge to affordability for numerous Medicare recipients.
