A new bill filed in the Senate July 20 aims to lift the ban on Medicare coverage of weight loss drugs such as Ozempic and Wegovy.
Federal law currently prohibits the Medicare program from paying for any weight loss drugs, or GLP-1s, and previous legislation to toss the ban has stalled in the past. GLP-1 drugs come with a steep price tag, costing upward of $10,000 per year without insurance.
The bill, formally called the Treat and Reduce Obesity Act of 2023, would likely spur more coverage of GLP-1s from commercial payers if passed, as many insurers' coverage policies closely follow the Medicare program.
The nation's largest payers told investors in the first quarter that coverage of GLP-1s has been almost entirely constrained to diabetes care. In a June survey from the Pharmaceutical Strategies Group, 49 percent of plans surveyed said they currently cover medications for weight loss, compared to 41 percent of employers.
In 10 states, Medicaid offers broad coverage for weight loss drugs, according to Bloomberg.
Novo Nordisk, which manufactures Ozempic and Wegovy, has lobbied for Medicare coverage of weight loss treatments since 2013, Politico reported in June. Eli Lilly hired a firm in January to lobby for its drug Mounjaro, a diabetes drug used off-label for weight loss.
If 10 percent of people with obesity covered by Medicare were prescribed a brand-name version of semaglutide, a type of GLP-1 drug, the drug would cost the program $26.8 billion annually, according to a study published in the New England Journal of Medicine in March.