Home » House Advances Bill to Allow Medicare Coverage of Weight Loss Drugs

House Advances Bill to Allow Medicare Coverage of Weight Loss Drugs

by Richard A Reagan

The House Ways and Means Committee advanced four bills on Thursday, aiming to allow Medicare to cover weight-loss drugs for certain beneficiaries. 

The vote, which passed 36-4, is a crucial step towards overturning a long-standing ban on Medicare-funded weight loss medications.

For over two decades, Medicare has been barred from covering weight loss drugs, excluding millions of potential beneficiaries. 

This ban has been particularly pronounced with the recent FDA approval of expensive weight loss drugs like Wegovy and Zepbound. These medications, without insurance coverage, remain out of reach for most Americans.

The Treat and Reduce Obesity Act of 2023, the focal point of Thursday’s vote, aims to change this. 

The bill, if enacted, would allow new Medicare beneficiaries who had a non-Medicare plan covering the drugs and a prescription at least a year before enrolling in the federal health program, to continue receiving these medications under Medicare.

Despite its passage in the committee, the bill’s scope is limited. 

Coverage would be restricted to those who had been on the medication prior to their Medicare enrollment and would only apply to individuals with obesity, not those who are overweight with a weight-related condition.

Committee chair Jason Smith (R-MO) described the bill as a starting point for broader coverage.

“I would like to see broader coverage,” Smith stated. “This bill has been around since 2013, and this is the farthest it has ever gone. If we wait on perfect here, we will wait another 11 years.”

The bill’s narrowed focus is largely due to financial concerns. 

The Congressional Budget Office has previously warned that covering weight loss medications under Medicare could lead to significant costs over the next decade. A monthly supply of drugs like Wegovy or Zepbound can exceed $1,000, making widespread coverage a substantial financial commitment.

Juliette Cubanski, deputy director of the program on Medicare policy at KFF, noted, “There’s a desire to find a way to make this more affordable. I think it would be concerning if all people get out of this is coverage for a very limited number of people.”

The bill now moves to the full House, though its future remains uncertain. Even if it clears the House, it must still pass the Senate and gain presidential approval to become law. The current session of Congress ends on January 3, 2025, adding urgency to the legislative process.

Sen. Bernie Sanders (I-VT), chair of the Senate Committee on Health, Education, Labor, and Pensions, is actively pressuring pharmaceutical companies to reduce drug prices.

Novo Nordisk, the maker of Wegovy, will testify in September about the pricing of its medications.

While the bill represents progress, some lawmakers expressed disappointment at its limited scope. 

Rep. Judy Chu (D-CA) commented, “This is a positive first step, but I’m disappointed that the pared-down version of this bill drastically reduces the number of seniors that will be covered.”

Despite these limitations, the advancement of the Treat and Reduce Obesity Act of 2023 signifies a crucial step towards expanding access to weight loss drugs for Medicare beneficiaries.

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