With approximately 42% of the U.S. population suffering from obesity, the Biden-Harris administration wants to expand coverage of anti-obesity drugs in the Medicare and Medicaid programs. The move, according to White House fact sheet released Tuesday, would ultimately save money and reduce the increased risk of excess weight, including diabetes, cardiovascular disease, stroke and certain cancers.

The drugs include, among others, the popular but expensive semaglutide drugs Wegovy and Ozempic. The Washington Post estimates proposal “provokes clash with RFK Jr.” President-elect Donald Trump has nominated Robert F. Kennedy Jr. to be secretary of the U.S. Department of Health and Human Services. He must be confirmed by the Senate.

The department’s current secretary, Xavier Becerra, told the Post that the proposal to expand anti-obesity drug coverage to 7.6 million people would cost Medicare about $25 billion and Medicaid about $11 billion over the next decade. States would reap about $4 billion as their share of Medicaid costs.

Becerra said the cost is only a “modest fraction” of what is projected for Medicare spending, estimated at nearly $2 trillion for drugs over the next decade.

Medicare provides health coverage to seniors and people with disabilities. Medicaid covers people with very low incomes.

RFK Jr. opposes drugs

The proposal is an overhaul of weight-loss drug coverage that hinges on recognizing obesity as a “chronic disease based on changes in medical consensus,” according to the Biden administration. Coverage would only extend to obese people, not those who are simply overweight.

Currently, weight loss drugs are specifically excluded from Medicare coverage unless they are intended to treat diabetes or heart disease. Bariatric surgery is covered in certain cases.

According to the Post, Trump’s new team does not need to finalize the proposal. And RFK Jr. is “an avowed critic of weight-loss drugs such as Ozempic, which he blame for obscuring the root causes of poor health in America.

RFK Jr. told Fox News last month, “they plan to sell it to the Americans because we are so stupid and so… addicted to drugs.” He said he plans to emphasize healthy eating and exercise as part of what he calls “Making America Healthy Again.”

This could spark a different kind of battle. As CNN reported“Dr. Mehmet Oz, whom Trump appointed to head the Centers for Medicare and Medicaid Services, has touted anti-obesity drugs on his talk show and on social media.

About obesity

The Centers for Disease Control and Prevention reported that between August 2021 and August 2023, around 4 in 10 adults were obese, with the highest rates among those aged 40-59.

The CDC notes that obesity is a chronic condition associated with the risk of many serious illnesses, including high blood pressure, stroke, and certain cancers, among others. Many experts consider obesity a chronic disease and not just a contributing factor.

The public health agency says it bases its figures on body mass index, which is weight in kilograms divided by height in meters squared. This has some limitations, the CDC reports, because “body fat can vary by gender, age, race, and Hispanic origin at a given BMI level.” A person suffers from obesity with a BMI of 30 and severe obesity with a score of 40 or more.

About 1 in 10 Americans suffer from severe obesity.

The drugs themselves at issue are forms of injectable semaglutide, which mimics the FLP-1 hormone that helps control blood sugar and appetite. According to NBC News, “drugmakers are working on dozens of other GLP-1 drugsstudying their long-term effects and exploring how they might help in other conditions.

The article notes studies suggesting this class of drugs could help people stop drinking alcohol, reduce sleep apnea and impact health.

“The high cost of anti-obesity medications, including the GLP-1 drugs Wegovy and Zepbound, has limited Americans’ access to these medications. Wegovy’s list price, for example, is about $1,350 for a four-week supply,” according to CNN.

The cost of treating obesity

According to the White House fact sheet: “In recent years, major scientific advances have been made in the treatment of obesity, with the introduction of new, life-saving medications. These anti-obesity medications can help prevent the development of type 2 diabetes. Additionally, these medications reduce death and illness from heart attacks and other cardiovascular problems by up to 20%. But for too many Americans, these essential treatments are too expensive and therefore out of reach. Without insurance coverage, these medications can cost up to $1,000 per month.

The proposal would expand drug coverage for obesity, which is a chronic condition for about 3.5 million people on Medicare. The announcement estimates that about 4 million adults on Medicaid would also be eligible.

The White House noted that the president is “proud of the fact that the Inflation Reduction Act allows Medicare to negotiate lower drug prices, a tool that will help Medicare reduce the cost of some of the program’s most expensive drugs.” . It has been noted that Americans pay two to three times more than those in other countries for the same drugs.

The fact sheet also states that seniors on Medicare benefit from lower insulin prices, capped at $35, and free vaccines, and will have their out-of-pocket spending on medications capped at $2,000 starting next year. He said nearly 1.5 million people with Medicare Part D saved nearly $1 billion on their share of drug costs in the first half of 2024 thanks to the Inflation Reduction Act .

A Congressional Budget Office Report in October, said that Medicare beneficiaries who are overweight or “suffer from obesity” fare worse in health outcomes and have higher health care costs due to their condition than those who are at a healthy weight. He estimates that the drug would cost Medicare about $35 billion between 2026 and 2034. It would actually cost more, but that figure is offset by the $3.4 billion in savings people will experience on drugs requiring less other health expenses.

The nonpartisan office notes that many factors could change this cost estimate, including price negotiation with the manufacturer, manufacturer rebates and changes in the number of eligible people, among others.

NBC News quoted a recent Health Affairs survey found that fewer than one in five large companies offer insurance covering weight-loss drugs.