Health and Human Services (HHS) Director Robert F. Kennedy Jr. mentioned he is contemplating a Medicare and Medicaid “regulatory framework” that encompasses GLP-1 medications for obesity treatment.
Kennedy noted in a CBS News Interview that the primary obstacle for coverage is the high price of the medication, but indicated that Medicaid and Medicare are looking into options to include the drug after patients have exhausted other alternatives.
“In an ideal scenario, I’d prefer to see medications available for use after trying other measures,” Kennedy stated.
“For instance, glucose monitors are quite effective, costing just $80 monthly. They have been proven to significantly help with weight loss and diabetes prevention,” he explained. “Health Planning not only involves dietary adjustments but also exercise.”
CBS News Chief Medical Correspondent Jon Lapook observed that these strategies have been “utilized for decades.” Kennedy countered by emphasizing the emergence of new technologies that enable individuals to track their progress.
“Presently, we possess the means to monitor it, allowing individuals to self-monitor and demonstrate that they have undertaken these steps,” Kennedy remarked.
“And should these methods fail, then you’ll have the entitlement to receive the medication,” Kennedy added, “That’s the structure we are currently exploring.”
In November, the Biden administration introduced new regulations aimed at providing coverage for drugs such as Wegovy and Zepbound for Medicare and Medicaid, thereby increasing accessibility for nearly 3.4 million Medicare beneficiaries and about 4 million Medicaid recipients.
However, the Centers for Medicare and Medicaid Services announced last Friday that they had completed the proposed rule and would not provide additional information.
Medicare currently covers GLP-1 medications when prescribed for conditions like diabetes or heart disease, but a regulation established in 2003 prevents Medicare from covering drugs solely for weight loss purposes.
Under the Biden administration’s proposal, older and/or low-income individuals with a body mass index of 30 or above would qualify for medication reimbursement.
Kennedy has previously criticized GLP-1 medications like Ozempic, arguing that these drugs are being pushed on Americans by foreign firms that do not sell the same medications in their own countries. Instead, Kennedy has emphasized dietary modifications to tackle obesity. He stated to CNBC last year that GLP-1 “has a role” in managing obesity.
This week, the HHS secretary labeled GLP-1 as a “remarkable drug” and pointed out cost as the greatest barrier to achieving Medicaid and Medicare coverage.
“We aim for everyone in Medicaid and Medicare to have access to these drugs, but the financial impact on our healthcare system will increase significantly,” Kennedy told CBS News. “One projection I encountered suggested that the average employer in the country would end up paying double what they currently spend on employees’ healthcare.”
Kennedy remarked that GLP-1 drugs represent a minor fraction of the costs incurred by other nations when compared to the US, adding that “President Trump instructed us to overcome anything associated with European pricing.”
