At a markup session June 27, the committee advanced the Treat and Reduce Obesity Act of 2023, which would provide Medicare coverage of the drugs in limited circumstances.
Under current law, Medicare cannot pay for any drug prescribed solely for weight loss. A version of theTreat and Reduce Obesity Act introduced in 2023 would have lifted the ban on Medicare payment for weight loss drugs, including Wegovy and Zepbound, but the bill did not gain traction in Congress.
The Ways and Means Committee since has passed an amended version of the law, which would allow Medicare to pay for weight-loss drugs for individuals prescribed the drugs for at least one year before receiving Medicare coverage. Rep. Jason Smith, Ways and Means Committee chair, introduced the amendment.
More than 1 million people could lose access to weight loss drugs as they age into Medicare in the coming years, Mr. Smith said at the session.
The amendment also narrows coverage for the drugs only for individuals with obesity. The broader version of the bill would have allowed coverage for individuals with obesity or overweight.
At the markup session, Mr. Smith said he would like to eventually see broader coverage of weight loss drugs in Medicare. Legislation to cover weight loss drugs has been on the table since 2013, Mr. Smith said, but has never received consideration at a markup hearing.
“These drugs are transformational for people’s lives. This is a step in [the right] direction. Is it perfect? Absolutely not. But if we wait for perfect here, we’ll be waiting another 11 years,” he said.
Now that the bill has advanced out of committee, the next steps remain unclear, Politico reported June 28. The bill could be part of an end-of-year health package passed during the lame duck session.
GLP-1 weight loss drugs have been approved for new uses since Congress last considered broadening Medicare coverage. In March, the FDA approved Wegovy to be used to reduce the risk of heart attack, stroke and cardiovascular death. Major insurers, including Elevance Health and CVS Health, said they would cover the drug for Medicare members when they are prescribed to treat cardiovascular conditions.
GLP-1 drugs can cost upward of $10,000 per year without insurance. A study published in the New England Journal of Medicine in March 2023 found if 10% of people with obesity covered by Medicare were prescribed a brand-name GLP-1 drug, the drug would cost the program $26.8 billion annually.
