Medicaid, Medicare may cover weight loss drugs under new pilot program: report

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The Trump administration is reportedly planning to roll out a five-year pilot program that would give obese people on Medicare and Medicaid access to groundbreaking and increasingly popular weight loss drugs, including Ozempic and Zepbound. 

According to The Washington Post, the plan is being developed by the Centers for Medicare and Medicaid Services and would be run through the Center for Medicare and Medicaid Innovation (CMMI) testing lab, which aims to lower costs and improve health outcomes by trying new ways to pay for health care.  

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How would the pilot work? 

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Big picture view:

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The pilot program would allow state Medicaid programs and Medicare Part D insurance plans to choose to cover Ozempic, Wegovy, Mounjaro and Zepbound for patients for “weight management” purposes, the paper reports. 

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A pharmacist holds boxs of Eli Lilly’s Mounjaro brand tirzepatide medication arranged at a pharmacy in Provo, Utah, US, on Monday, Nov. 27, 2023. Prescriptions of appetite suppressing GLP-1 weight-loss drugs skyrocketed 300% from 2020 to 2022. Photog –> <!–>

It’s a reversal for the administration: In April, officials said Medicaid and Medicare would not cover the drugs solely for weight loss. A Biden administration proposal would have allowed the programs to cover GLP-1s, but the April decision scrapped that plan. 

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RELATED: Study finds weight can return months after ending use of anti-obesity drugs

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The proposal isn’t final and may go through a formal process soliciting public opinions before it is. 

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Timeline:

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The experimental program would begin in April 2026 for Medicaid and January 2027 for Medicare plans, according to The Post. 

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By the numbers:

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According to the Centers for Disease Control and Prevention, more than 100 million adults in the U.S. are obese — defined as having a body mass index of 30 or higher — and more than 22 million adults are severely obese, with a BMI of 40 or higher.

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RELATED: Popular weight loss drugs could help with alcohol, opioid addictions: study

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Medicare provides health care coverage for 66 million Americans. The Congressional Budget Office has estimated that covering the drugs would cost Medicare about $35 billion from 2026 to 2034.

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Why are GLP-1 drugs so popular? 

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The backstory:

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The drugs are part of a new class of medications known as GLP-1 receptor agonists that work by mimicking hormones in the gut and brain that regulate appetite and feelings of fullness. Tirzepatide (Zepbound and Mounjaro) targets two such hormones, known as GLP-1 and GIP, while semaglutide (Ozempic and Wegovy) targets GLP-1 alone

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Originally meant to treat diabetes, the drugs surged in popularity after the Food and Drug Administration approved them for weight loss in 2021. Now, they’re all over the place — celebrities, TV advertisements, social media, news media, your neighbor.

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What they’re saying:

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Doctors and researchers say the injectable drugs are effective tools when it comes to treating obesity. The American Medical Association has urged health insurance companies to cover the drugs, and the American Academy of Pediatrics has said that doctors should consider giving the medications to kids 12 and older who are struggling with obesity.

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Without insurance, out-of-pocket costs for the drugs can run hundreds of dollars each time you fill a prescription. Insurance coverage has been an issue, and mostly limited to employers with 500 employees or more. 

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The other side:

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Research has shown that most people regain the weight they lost once they stop taking the drugs, which has led to concerns about the cost of it being a lifetime medication. 

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Mixed messaging from Trump administration

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Dig deeper:

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Mehmet Oz, administrator of the Centers for Medicare and Medicaid, has touted GLP-1s as a “big help” for weight loss. Health secretary Robert F. Kennedy, however, has criticized the drugs and argued that Americans can lose weight with diet and exercise alone.  

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The Source: This report includes information from The Washington Post, The Associated Press and previous LiveNow from FOX reporting. 

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