A bipartisan, bicameral group of lawmakers reintroduced the Treat and Reduce Obesity Act last month, which would allow more health care providers, services and drugs to be covered under Medicare.
The bill was first introduced over a decade ago, but initial clinical trial results suggesting that Wegovy can reduce the risk of serious heart problems is lending it new momentum.
Still, while Congressional staffers say the bill is a priority for the sponsors, lawmakers will have only a few weeks to avert a government shutdown when they return from their August recess, meaning its best chance of passing this year is attaching it to some kind of spending bill.
Medicare beneficiaries can access some obesity care services through Medicare Part B such as an initial BMI assessment or nutritional counseling. They can also get services by buying enhanced coverage through Medicare Advantage.
Even then, these services are only covered if they occur in a primary care setting where patients are unlikely to access specialized treatment.
Medicare Part D is barred from covering anti-obesity medications due to a 20-year-old piece of legislation called the Medicare Modernization Act.
The 2003 bill was informed by the use of the drug known as “Fen-Phen” that became popular during the 1990s for its ability to cause rapid weight loss but also came to be associated with serious side effects like heart disease.
Newer drugs like Wegovy appear to have reignited enthusiasm for expanding Medicare coverage, with drug manufacturer Novo Nordisk carrying out a campaign to have its medication covered by the federal plan.
The latest legislation has yet to be scored by the Congressional Budget Office. But covering Wegovy could mean several billions more in Medicare spending if beneficiaries choose to take the drug, with one study estimating it would cost $13.6 billion if just 10 percent of beneficiaries with obesity took the medication.
Weight loss drugs and the push for Medicare coverage
