House panel advances bill to cover weight loss drugs under Medicare

A bill to let Medicare cover popular weight loss drugs like Wegovy and Ozempic passed a key committee in the House of Representatives Thursday.

The House Ways and Means Committee overwhelmingly voted to pass the Treat and Reduce Obesity Act of 2024. The bill would allow Medicare Part D plans to cover glucagon-like peptide agonists, or GLP-1s, for "treatment of obesity" for people who have been prescribed the medications before enrolling in Medicare.

Related: Cryptic insurance rules hinder GLP-1 access for weight loss

In March, the Centers for Medicare and Medicaid Services issued guidance saying Part D could cover the weight loss drugs if they are prescribed for heart disease or strokes. Weight loss alone is not covered under the guidance.

Ways and Means Committee Chair Jason Smith (R-Mo.) said allowing the drugs to be covered for weight loss alone made sense to prevent related ailments and cut costs in the future.

"Obesity is a risk factor for numerous other diseases and leading causes of death such as diabetes, heart disease, and cancer," Smith said, pointing to a June report by the Joint Economic Committee that estimated obesity will cost the federal government more than $4 trillion over the next decade. "We need to get a handle on this growing problem now."

Smith said that if Congress does not act, people taking such drugs would have to stop them when they enroll in Medicare.

"Without this legislation, millions of Americans aging into Medicare in the coming decades will lose coverage to these medications which have helped them live healthier, more active lives," Smith said.

If the measure becomes law, it could further spike demand for drugs that are already presenting problems for insurers and their makers. Manufacturers have struggled with supply issues and insurers have been imposing restrictions beyond the FDA’s labeled uses.

Still, the committee estimated the measure would cost a relatively modest $1.7 billion over its first 10 years since it would only apply to people who had a GLP-1 prescription in the year before going on Medicare.

Some committee members saw the bill as a first step to broader coverage, though the impact on federal spending is likely to be significant in that case. A recent report by the Senate Health, Education, Labor and Pensions Committee estimated that Novo Nordisk's Wegovy could cost $400 billion a year if half of obese Americans took it.

Rep. Lloyd Doggett (D-Texas) said during the hearing that covering just 10% of the people on Medicare for GLP-1s would cost $27 billion a year.

Doggett, who was among the four Democratic committee members opposing the bill, and others suggested Congress should work to compel manufacturers to bring down the costs. Senate HELP Committee Chair Bernie Sanders (I-Vt.) has set a hearing with Novo Nordisk CEO Lars Jorgensen for September.

Rep. Gwen Moore (D-Wis.) was sympathetic to suggestions that Congress do more to address high drug prices but said lawmakers could at least take this smaller step to make sure people benefitting from the drugs don't lose them simply because they retire.

"I hear my colleagues say that this would be an unprecedented move in how we provide Medicare to beneficiaries, that this would only help the lucky few who had coverage before enrolling in Medicare," Moore said. "Why would we want to punish these folks, and likely create a setback in their fight against obesity?"

Passage of the bill in committee allows it to go to the House floor for a vote. It is unclear what its prospects are in the Senate, where its counterpart version also has bipartisan support but has not yet gotten a hearing.

Also passed in the Ways and Means session Thursday were measures to cover multi-cancer screenings, including for people before they enroll in Medicare; to undertake a food as medicine pilot in Medicare; and to cover certain self-administered home infusions.