Manufacturers lobbying Congress for Medicare coverage of new weight loss drugs

Drug manufacturers are lobbying for Medicare to cover the cost of expensive new drugs meant for treating obesity, The Wall Street Journal reported April 24. 

Lawmakers are unlikely to extend Medicare coverage to weight loss drugs at their current price tag, the Journal reported. Under current law, Medicare does not cover any weight loss drugs. 

According to the Journal's reporting, Sen. Bill Cassidy, a Louisiana Republican, is working with the Congressional Budget Office to find ways to bring down the cost of the program before reintroducing legislation that would require Medicare to cover obesity treatments. 

Wegovy, manufactured by Novo Nordisk, costs upward of $10,000 a year without insurance coverage, the Journal reported. 

GLP-1 drugs, including Ozempic, Trulicity, Victoza and Mounjaro are used to treat Type 2 diabetes. Wegovy and Saxenda are approved for weight loss.  

If 10 percent of people with obesity covered by Medicare were prescribed a brand-name semaglutide, a type of GLP-1, the drug would cost Medicare $26.8 billion annually, according to a study published in the New England Journal of Medicine in March. This represents 18.5 percent of current Medicare Part D spending. 

Novo Nordisk has lobbied for Medicare coverage of weight loss treatments since 2013, the Journal reported. Elli Lilly joined the effort in 2021. 

Manufacturers are hopeful private insurers will follow if Medicare covers weight-loss drugs. 

Payers typically do not cover newer drugs meant for treating obesity but do often cover drugs meant to treat diabetes. GLP-1 drugs marketed for weight loss are typically not covered, though the same drug marketed for diabetes treatment is typically covered.

Elevance Health does not cover GLP-1 drugs prescribed only for weight loss, except in states that require coverage of the drugs by law. 

UnitedHealthcare is seeing increased usage of GLP-1 drugs, mostly to treat diabetes, UnitedHealthcare CEO Brian Thompson told investors April 14. 

"The overwhelming majority of that is in diabetic care, and it is as we had expected, low single digits in terms of weight loss use. I would say that our on-label usage has been well managed with our authorization requirements," Mr. Thompson said. 

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