Among his final acts as President of the United States, Joe Biden proposed Medicare coverage of Ozempic for obese individuals. It will be up to the Trump administration to decide whether to finalize this proposal or kill it. What would RFK Jr. do about Medicare coverage of Ozempic if he is confirmed as head of the US Department of Health and Human Services posits Jonathan Cohn for The Huffington Post?
Cohn explains that Medicare coverage of Ozempic would be consequential for millions of people. It would deliver potentially significant benefits to them. At the same time, it could cost the Medicare program a tremendous amount of money.
Ozempic is a glucagen-like peptide or GLP-1 agonist because it works just like a hormone in our bodies that reduces our blood sugar and desire to eat. GLP-1’s have delivered health benefits since the early 2000’s. They became popular when they could be taken once a week. They are also sometimes referred to as semaglutide.
Semaglutide–marketed in some cases as Ozempic or Wegovy–treats diabetes, heart disease as well as weight loss. But, it is quite costly, with prices as high as $1,000 a month.
Today, Medicare only covers semaglutide for people with diabetes and heart disease. By law Medicare covers medically reasonable and necessary treatments for health conditions, with a few exceptions, including weight-loss. The Biden administration is now arguing that when people are found to be obese, it threatens their health, and a semaglutide affords them medically reasonable and necessary treatment.
If the Trump administration finalizes coverage of semaglutide, the price tag is projected to be around $40 billion over ten years. More than ten percent of the 65 million people with Medicare are obese. But, if the Trump administration does not repeal Biden’s Inflation Reduction Act, which allows for Medicare drug price negotiation, the federal government would have the power to pay a lower price for the drug beginning in 2027.
RFK Jr. has said that he opposes coverage of semaglutide. He argues that obesity stems from malnutrition. We should be spending taxpayer dollars on healthy meals for Americans, not using it to boost Pharma profits.
To be clear, the evidence shows that people are obese for a number of reasons, and many of those reasons have nothing to do with healthy eating.
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