Millions of Americans suffer from obesity, and the disease costs the healthcare industry over $170 billion each year because treating obesity-related ailments, such as cardiovascular disease, diabetes, and stroke, is very expensive.
While recent advances in medicine have created prescription anti-obesity GLP-1 medications — like Ozempic, Wegovy, and Mounjaro — accessibility to these drugs is limited.
The average prescription costs $1,000 per month, and consumers must foot the bill out of pocket as most public and private healthcare plans don’t yet cover weight-loss drugs for people unless they are obese or have been diagnosed with diabetes.
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That might be changing.
The Biden-Harris administration's Inflation Reduction Act in 2022 allowed the Medicare program to negotiate drug prices down. This benefit now applies to some weight-loss drugs, which can reduce the inflated prices Americans pay for their prescriptions — often double or triple the cost of what people in other countries pay. Consumers who previously thought weight-loss drugs were out of their price range may soon be able to access monthly prescriptions.
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Weight-loss drugs will become more affordable for Medicare and Medicaid recipients
The administration recently announced its plan to enact widespread coverage of anti-obesity medications for Americans on Medicare and Medicaid. They estimate this will help over 7 million Americans on Medicare and Medicaid get coverage.
Though Medicare already covers GLP-1s for chronic conditions like diabetes and obesity, this policy update from the White House would expand coverage to include prescriptions based on weight loss.
This historic change could reduce out-of-pocket costs for popular weight-loss drugs by up to 95%, allowing people to lead fuller, healthier lives.
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45% of patients prescribed GLP-1s cite high prices as the reason for discontinuing the medication, and 65% of those interested in GLP-1s note that prices are the biggest barrier preventing them from exploring them. Increasing accessibility through broad healthcare coverage allows a clear path to widespread usage and long-term healthcare benefits.
Expanding coverage of weight-loss drugs comes at a cost
While this initiative is an important step forward, the incoming Trump administration must uphold the policy in order for it to take hold long-term. Trump and many of his cabinet appointees have vowed to slash any unnecessary federal spending and have considered cutting entire federal departments and agencies.
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However, Dr. Mehemt Oz, Trump’s recent nominee for the Centers for Medicare and Medicaid Services, has previously supported increasing GLP-1 affordability to address the growing obesity epidemic in the U.S.
The Congressional Budget Office estimates that expanding Medicare to cover weight-loss drugs would increase federal spending by $35 billion between 2026 and 2035 alone. While it may seem unlikely that a Trump administration determined to cut any government spending it deems wasteful will commit to expanding Medicare, it is not impossible.
Those awaiting broad GLP-1 coverage will have to wait and see if the Senate confirms Dr. Oz's appointment to oversee the Centers for Medicare and Medicaid Services and if he stays true to his previous support of weight-loss drugs.
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