Medicare to Cover Blockbuster Obesity Drugs

https://www.medpagetoday.com/publichealthpolicy/medicare/118344

Monthly drug prices slashed by hundreds in deal with drugmakers

Medicare will cover semaglutide (Wegovy) and tirzepatide (Zepbound) for their weight management indications for people with obesity, President Trump announced on Thursday.

“Until now, neither of these two popular drugs have been covered by Medicare for weight loss, and only rarely by Medicaid,” Trump said during a press conference in the Oval Office. “That ends starting today …. This will improve the health of millions and millions of Americans.”

As part of a new deal with the White House, doses of Novo Nordisk and Eli Lilly’s blockbuster drugs for patients without insurance will be priced at $350 through TrumpRx for a month’s supply — the GLP-1 receptor agonists currently carry list prices of over $1,000 per month. Starting doses of new, pill versions of the treatments also will cost $149 a month if they are approved. The TrumpRx website is expected to launch before the end of the year.

A senior administration official said coverage of the drugs will expand to Medicare patients starting next year, with Medicare paying $245 for semaglutide and tirzepatide. Those who qualify will pay $50 copays for the medicine.

The type 2 diabetes formulations of semaglutide and tirzepatide — sold under the brand names Ozempic and Mounjaro, respectively — have been covered under Medicare, but historically the program has not paid for drugs indicated for weight loss alone.

Since last year, Medicare has covered the weight-loss formulations of GLP-1 products under its Part D drug program if beneficiaries had a separate FDA-approved indication

: semaglutide gained coverage for patients with overweight or obesity who have preexisting heart disease and need the drug to prevent heart attacks or strokes; and tirzepatide gained coverage for those with obesity and moderate to severe obstructive sleep apnea.

“Obesity is not an absence of GLP-1 drugs,” Mehmet Oz, MD, MBA, administrator of the Centers for Medicare & Medicaid Services, said at the press conference. “We’re all clear on that. But … it is an arrow in our quiver that we must use and should use.”

HHS Secretary Robert F. Kennedy Jr. said “if we want to solve the chronic disease crisis, we have to tackle obesity.” He noted that 50% of U.S. adults are obese or overweight, which contributes to higher healthcare costs.

“The announcement of a lower price for Ozempic and other anti-obesity drugs is made possible by Medicare negotiation

, which Democrats passed with no Republican support,” said Sen. Ron Wyden (D-Ore.), in a statement.

Wyden added that one of Kennedy’s first actions as HHS secretary was to revoke a plan to allow Medicare to cover these drugs.

In November 2024, the Biden administration had proposed

Medicare and Medicaid coverage of GLP-1 agents when indicated for obesity alone (though not for individuals considered just overweight), but the Trump administration scuttled those plans

. Biden’s proposal was expensive: It would have included coverage for all state- and federally funded Medicaid programs for people with low incomes, costing taxpayers as much as $35 billion over the next decade.

Trump administration officials said the new lower prices also will be provided for state- and federally funded Medicaid programs.

Polls show Americans favor having Medicare

and Medicaid cover the costs. But many insurers, employers, and other bill payers have been reluctant to pay for the drugs, which can be used by a wide swath of the population and can cost hundreds of dollars a month.

One study from last year

found that half of U.S. adults were eligible for semaglutide’s indications, including an estimated 26.8 million insured by Medicare.

Proponents of the coverage have argued that treating obesity can actually reduce longer-term costs by cutting down on heart attacks and other expensive health complications that can arise from the disease.

The benefits consultant Mercer has said that 44% of U.S. companies with 500 or more employees covered obesity drugs last year. More than a dozen state Medicaid programs already cover the drugs for obesity.

Filed under: General Problems