Millions of Americans could have had Medicare and Medicaid expanded to cover the blockbuster weight-loss drug under proposed federal rules announced Tuesday.
This drug (part of a class of drugs called GLP-1, or glucagon-like peptide-1, receptor agonists) was first used to treat diabetes, but was later also approved for obesity, and patients numbers have expanded dramatically. This drug helps people reduce their appetite and lose weight.
New rules from the Biden administration aim to expand access. According to , approximately 42% of American adults are obese. Centers for Disease Control and Prevention. This is up from 30% in 1999-2000.
Private insurers say U.S. patients are not paying the true cost of expensive drugs such as Wigovy and Zepbound, which can easily exceed $1,000.
What is the actual cost of GLP-1?
Novo Nordisk’s weight-loss drug Wegoby sells for $1,349 in the United States, but a fraction of that in Europe. It costs $92 in the UK, according to evidence presented at a US Senate committee hearing in September.
In the United States, insurance sponsored by employers and private insurance companies covers most diabetes drugs such as Ozempic. The drug’s injection pen costs about $970 a month at list price, according to the manufacturer. novo nordisk.
The list price of Zepbound, a weight management drug manufactured by pharmaceutical giant Eli Lilly, is $1,060 for a 28-day supply. GoodRX.com Said.
How much is usually covered?
The number of employers covering GLP-1 drugs appears to be increasing. A recent study by benefits consultant Mercer found that 44% of large employers cover obesity, up from 41% in 2023.
What does expanding Medicare and Medicaid coverage mean?
Medicare is a federal program that provides health insurance to Americans age 65 and older. A new rule expanding coverage from the U.S. Department of Health and Human Services will affect 3.4 million Medicare beneficiaries.
Medicaid provides insurance to low-income Americans. About 4 million Medicaid recipients could receive coverage under the proposed rule. The state would have the option of paying for it.
Centers for Medicare and Medicaid Services officials estimate the expansion will cost about $40 billion over 10 years.
It is unclear how the Trump administration will handle this proposal. But Robert F. Kennedy Jr., President-elect Donald Trump’s pick to lead HHS, said Americans should eat more.
Once finalized, the rule would go into effect in 2026.
USA TODAY’s Karen Weintraub and Alyssa Goldberg contributed to this report.
