Bill Advances to Have Medicare Cover Weight Loss Drugs

NBC News

For more than two decades, Medicare has been banned from paying for weight-loss drugs, preventing millions of potential patients who could benefit from them from receiving them.

The ban has been even more evident in recent years, following the Food and Drug Administration’s approval of powerful but expensive drugs such as Wegovy and Zepbound, which, without insurance, are only accessible to the wealthiest members of society.

On Thursday, a House committee took some of the first steps needed to change that law, which would allow Medicare to pay for weight loss drugs for the first time. The Ways and Means Committee voted in favor of a bill called the Obesity Treatment and Reduction Act of 2023.

The vote marked a pivotal moment for the bill, which has languished for more than a decade in Congress. The proposal has been introduced several times but has never been brought up for a committee vote, as it was Thursday.

The law will now go to the full House of Representatives, although it is not yet clear if it will obtain enough votes to be approved.

Even if it passes the House, it would need to be backed by the Senate and receive President Joe Biden’s signature to become law. Time is running out: The current session of Congress will end on January 3, 2025. Projects that have not become law before that date will have to be reintroduced when the next Congress is installed, meaning the process would start again.

“This is the first step on a path that is still very uncertain,” said Juliette Cubanski, deputy director of the Medicare policy program at KFF, a nonprofit group that researches health policy issues. “There are probably a lot of other things on the agenda in Congress that they want to accomplish,” she said.

In March, the federal government announced that Medicare would pay for Wegovy. However, coverage is limited to patients at higher risk of heart attack, stroke or other serious cardiovascular problems.

The legislation that the Ways and Means Committee voted on Thursday was a slimmed-down version of the original text of the Obesity Treatment and Reduction Act. This version would limit coverage people who have taken a weight-loss drug for a year before enrolling in Medicare. Coverage would also apply only to people with obesity, excluding those who are overweight with at least one weight-related condition. (Currently, the FDA says weight-loss drugs can be prescribed to both groups.)

The new version of the bill would also make changes to the way intensive behavioral therapy — a treatment approach that offers patients nutrition and exercise counseling but does not include weight-loss drugs — is covered.

“While this is a positive first step, I am disappointed that the shortened version of this bill will dramatically reduce the number of people who will be able to access these medications,” Democratic Congresswoman Judy Chu said during a debate before the vote.

Committee Chairman Jason Smith, a Republican, said he understood the disappointment, adding that he would like to see broader coverage of weight loss drugs.

“This bill has been around since 2013,” Smith said. “If we wait for it to be perfect, we’re going to have to wait another 11 years.”

Cubanski said it appears the changes to the bill were intended to make it more budgetarily attractive to lawmakers.

Monthly supply of Wegovy or Zepboud can cost more than $1,000. The Congressional Budget Office has previously warned that if Medicare covered weight loss drugs, the net cost to the program “would be significant over the next 10 years.”

“There seems to be a desire to find a way to make this more affordable,” Cubanski said. “I think it would be worrying if all this achieves is coverage for a very limited number of people.”

Meanwhile, Senator Bernie Sanders, independent from Vermont and chairman of the Senate Health, Education, Labor and Pensions Committee, is leading a public pressure campaign to force Novo Nordisk, maker of Ozempic and Wegovy, to lower the cost of their medications.

Earlier this month, the committee announced that Lars Fruergaard Jørgensen, chief executive of Novo Nordisk, had agreed to testify in September about the prices of its popular weight-loss drugs.