Press ESC to close

House Committee Advances Bill to Allow Medicare Coverage for Weight Loss Drugs

In a significant legislative development, the House Ways and Means Committee has passed a bill that could pave the way for Medicare to cover weight loss medications for the first time. The Treat and Reduce Obesity Act, which has been stalled in Congress for over a decade, was approved by the committee on Thursday, moving it closer to a full House vote.

For more than twenty years, Medicare has been restricted from covering weight loss medications, limiting access for numerous potential beneficiaries. This issue has become more pronounced with the recent approval of expensive drugs like Wegovy and Zepbound by the Food and Drug Administration (FDA), making them unaffordable for many without insurance coverage.

The committee’s vote marks a crucial step for the bill, which aims to include weight loss drugs in Medicare coverage. The next steps involve securing enough votes in the House, passing the Senate, and ultimately receiving the president’s endorsement before the current Congressional session concludes on January 3, 2025.

Juliet Cubanski, deputy director of the program on Medicare at KFF, commented on the bill’s uncertain path ahead, acknowledging the competing priorities on the congressional agenda that could impact its progress. “The road ahead for this bill is still challenging, given the many other issues Congress is dealing with,” Cubanski noted.

In March, Medicare announced limited coverage for Wegovy, restricted to patients at higher risk of cardiovascular issues. The revised version of the Treat and Reduce Obesity Act considered by the committee narrows the coverage scope to individuals who have used weight loss drugs for a year before enrolling in Medicare, focusing solely on those with obesity and excluding overweight individuals with at least one weight-related condition.

The bill also proposes changes to how intensive behavioral therapy is covered, a treatment method involving counseling on diet and exercise but excluding weight loss medications. While some lawmakers expressed disappointment over the bill’s limitations, Committee Chair Jason Smith emphasized the need for progress despite the bill’s scaled-back nature. “This is a step in the right direction, even if it’s not everything we hoped for,” Smith said.

The adjustments to the bill seem aimed at enhancing its financial viability for lawmakers, with concerns raised over the substantial costs associated with drugs like Wegovy and Zepbound. Efforts are underway to address the affordability of these medications to ensure broader access beyond a limited group of individuals.

Simultaneously, Senator Bernie Sanders is leading an advocacy campaign to pressure Novo Nordisk, the manufacturer of Ozempic and Wegovy, to reduce the prices of these popular weight-loss drugs. The Senate Committee on Health, Education, Labor, and Pensions announced that the CEO of Novo Nordisk has agreed to testify in September regarding the pricing of these medications.

As the bill progresses through the legislative process, its potential impact on Medicare beneficiaries and the broader healthcare system will be closely monitored. The outcome of this legislative effort could significantly alter the landscape of weight loss treatment for seniors in the United States.