Representative Brad Robert Wenstrup is co-sponsor of the bill. Credit: Office of Rep. Brad Wenstrup
For more than two decades, a law has prohibited Medicare from covering weight loss drugs. However, on Thursday, the House Ways & Means Committee passed obesity drug coverage legislation that would bridge the gap for those 65 and older to get their weight loss drugs paid for by Medicare.
Presently, Medicare is prohibited from covering medications used for weight loss, such as Wegovy, Ozempic and Zepbound.
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The new bill, Treat and Reduce Obesity Act of 2023, is primarily targeted toward people currently on weight loss drugs – and have already taken the drugs for at least a year – who won't get kicked off when they enter the Medicare program.
"As a physician and lawmaker, I have worked to ensure patients can access critical health care treatments they need," said the bill's co-sponsor, Rep. Brad Wenstrup (R-OH). "The House Ways and Means Committee's actions today to increase access to breakthrough medical devices and expand coverage of weight loss treatments for Medicare beneficiaries are a strong step towards that goal."
"With two out of three adults in the United States currently obese or overweight, Congress has a responsibility to remove inappropriate barriers to new medications that can help us fight back against the chronic disease epidemic in America that is linked to obesity …," said House Ways and Means Committee Chairman Jason Smith (R-Mo.). "This legislation will allow millions of seniors entering Medicare to maintain their treatment on anti-obesity medication, ensuring continuity of care and driving down their long-term health care costs."
The new bill only provides coverage for people who had an insurance plan that covered weight loss drugs before they entered Medicare, which could disadvantage patients with less generous plans, said Rep. Richard Neal (D-Mass.). "I am concerned about turning Medicare into haves for those with good private insurance, and have-nots for those who don't," he said. "The rationing under this bill doesn't align with our goal of unlocking access regardless of wealth."
The bill was originally intended to overturn the 20-year restriction on the coverage of drugs to treat obesity under Medicare, however, it now only covers new enrollees in Medicare Part D, which helps cover the cost of prescription drugs for those 65+. The bill will prevent an estimated 1.25 million patients from losing coverage over the next decade.
"The bill is an important step forward to ensure that seniors in Medicare do not lose access to vital treatment and paves the way for future expanded coverage of these treatments in Medicare," said Rep. Wenstrup. "Tackling obesity head-on can help prevent numerous additional diseases, such as heart disease and diabetes, and help keep Americans healthier for much longer. Not only a longer lifespan, but a longer health span."
Related: Making the case for Wegovy coverage: Drug keeps weight of for 4 years, aids heart health
The bill is "important first step" in improving access to these drugs, adding that it is "encouraged by the bipartisan support and the commitment demonstrated by both sides of the aisle to expand coverage in the future," said patient organization Obesity Action Coalition, in a statement.
The new bill will now make its way to the full House. The Senate Finance Committee is also expected to consider the new bill, however, the current session of Congress will end on Jan. 3, 2025.
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