Cheap Ozempic? How millions of Americans with obesity could gain access to expensive weight-loss drugs

WASHINGTON (AP) — Millions of obese Americans would gain access to popular weekly injections that would help them shed pounds quickly if a $35 billion Biden administration proposal gets the blessing of President-elect Donald Trump.

The rule unveiled Tuesday by the Department of Health and Human Services would require Medicare and Medicaid to cover weight-loss medications like Wegovy or Zepbound for a large portion of obese Americans.

But it is unclear whether the proposal, which would not take effect until after Trump takes office, will be supported by his new administration — including by Robert F. Kennedy Jr., a drug opponent whom the president-elect has recruited to head HHS.

Here’s what you should know about the drugs and the Biden administration’s proposal:

The medications work by regulating appetite

The weight loss drugs, also called anti-obesity drugs or GLP-1, mimic the hormone called glucagon-like peptide 1, which regulates appetite by mediating satiety between the gut and brain when eating.

The drugs include Novo Nordisk’s Wegovy and Ozempic and Eli Lilly’s Zepbound and Mounjaro.

In clinical trials, most participants who took Wegovy or Mounjaro to treat obesity lost an average of 15 to 22% of their body weight – in many cases up to 50 pounds or more. But some of the “nonresponders” did not lose any significant body weight.

Private health insurance only covers medications to a limited extent. Medicare has been prevented from covering them because of a law that says the program cannot cover weight-loss products. Medicaid coverage now varies from state to state.

That means the drugs — which can cost more than $1,000 a month — have been largely unaffordable for many.

It would benefit millions but cost billions

The rule announced Tuesday affects Medicaid, which provides health insurance coverage to about 70 million of the nation’s poorest people, and Medicare, the health insurance program for about 67 million older Americans.

Under the proposal, the Centers for Medicare and Medicaid Services (CMS) would reinterpret federal law to consider the drugs as treatments for obesity-related diseases.

The nation’s top health agency estimates that up to 3.5 million people on Medicare and 4 million people on Medicaid could qualify for coverage for the drugs. But research suggests that far more people may qualify: The Centers for Medicare and Medicaid Services estimates that about 28 million people who receive Medicaid are considered obese.

And the proposal would cost a lot of money — at least $35 billion over the next decade.

It’s not clear whether Trump will support it

The drugs are extremely popular – in a survey by health care company KFF earlier this year, a majority of Americans said Medicare should cover the drugs. A bipartisan coalition of lawmakers has also pushed for coverage of the drugs.

But support in Trump’s inner circle is mixed.

Kennedy has railed against the idea of ​​Medicare or Medicaid covering the drugs. Instead, he told Congress they should expand coverage of healthier foods and gym memberships through government-sponsored health programs.

Meanwhile, Dr. Mehmet Oz, who is about to take over as head of CMS, said the drugs could be a helpful tool. In a video posted to Instagram last year, Oz praised some of the drugs’ benefits but said the long-term effects should be further studied.

“I think this new generation of drugs presents us with a great opportunity,” Oz said.

Trump or Kennedy could ultimately ignore Biden’s proposal and not implement it.

Some MPs praised the move on Tuesday, but others expressed skepticism.

Rep. Brad Wenstrup, a Republican who has introduced a bill that would impose costs on weight-loss drugs on Medicare, has argued that covering the cost of drugs and other obesity treatments could save taxpayers in the long run.

“I am encouraged to see the administration support our efforts to make Americans healthier by allowing Medicare to cover new, physician-prescribed, FDA-approved obesity medications,” Wenstrup said in a statement.

He called on Congress to pass legislation that would help fund dietitians, nutritionists and behavioral health providers to treat obesity.

However, Senator Bernie Sanders warned that Medicare premiums under the plan would “skyrocket” if the government did not require drugmakers to lower drug prices.

Doctors praise the medication, but still have concerns

It’s good that more Americans have access to these medications, which have been proven to be effective, but Dr. David Ludwig, a nutrition and obesity expert at Harvard University, hopes they don’t become the primary treatment for obesity in America.

He worries that there isn’t enough investment being made to understand what’s driving the rising obesity rate in the U.S. and what role healthy diet and exercise might play in solving this epidemic.

“It is appropriate to treat the problems we face now with medication, but we must not stop there,” Ludwig said. “Let’s figure out what’s causing the problem and ultimately rely on these medications, which have fewer and fewer side effects over time.”

Dr. Andrew Kraftson, who treats obese patients at the University of Michigan, is glad that more of his patients may be able to afford the medications he has prescribed to patients that have produced successful results. But he would also like to see more research and guidance from the government on prescribing the drugs.

Kraftson also worries about some side effects in older patients. He points out that the drugs can cause muscle loss, which is a bigger problem for older Americans, for example, who are at risk of falls.

“I advocate for their judicious use,” Kraftson said. “Because if you have a senior and you just give them a prescription and the visit lasts five minutes, is that an appropriate level of care? Have we defined this well?