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Medicare, the federal health program for adults 65 and older, has been prohibited by law from covering weight loss drugs for older Americans who are obese but do not have diabetes or heart disease.
Why Doesn’t Insurance Cover Semaglutide for Weight Loss? Ozempic is approved by the U.S. Food and Drug Administration (FDA) to: Help people with type 2 diabetes manage blood sugar levels
In 2021, House lawmakers introduced The Treat and Reduce Obesity Act, which would have allowed the federal government to expand Medicare Part D coverage to include weight loss medications.
But research suggests far more people might qualify, with the Centers for Medicare and Medicaid Services estimating roughly 28 million people on Medicaid are considered obese. Medicare has been barred from offering the drugs under a decades-old law that prohibits the government-backed insurance program from covering weight-loss products.
The Centers for Medicare & Medicaid Services estimated that coverage under the Biden proposal would cost about $40 billion over 10 years, including an extra $3.8 billion for states.
The proposed rule would make an estimated 4 million Medicaid recipients and 3.4 million Americans on Medicare eligible for the drug, which can retail for over $1000 per month without coverage.
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