Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. said he is considering a “regulatory framework” for Medicare and Medicaid to cover GLP-1 medications to treat obesity.
Kennedy said in a CBS News interview that aired Wednesday the high cost of the medication is the biggest hurdle to coverage, but he said he’s considering a proposal for Medicaid and Medicare to cover the drug once patients have established they’ve exhausted other options.
“Ideally, over the long term, we’d like to see … those drugs available for people after they try other interventions,” Kennedy said.
“Glucose monitors, for example, which are very, very effective and only cost $80 a month, and they’ve been shown to be extraordinarily effective in helping people lose weight and avoid diabetes,” he continued. “Health regimens — including, particularly, change in diet, but also exercise.”
CBS News chief medical correspondent Jon LaPook noted those methods have “been tried for half a century.” Kennedy responded by emphasizing the availability of new technology to track individual progress.
“Now, we have ways of monitoring it, so that people can monitor themselves, and they can show that they’ve done these interventions,” Kennedy said.
“And if they don’t work, then you would be entitled to the drug,” Kennedy added, noting, “that’s the framework that we’re now debating.”
In November, the Biden administration proposed a new rule that would allow drugs like Wegovy and Zepbound to be covered by Medicare and Medicaid, expanding access for roughly 3.4 million Medicare users and about 4 million Medicaid enrollees.
But the Centers for Medicare and Medicaid Services said in a notice last Friday that it would not be finalizing this proposed rule, providing no further details.
Medicare does cover GLP-1 drugs when prescribed for conditions like diabetes and heart disease, but legislation from 2003 prohibits Medicare from covering drugs solely for weight loss.
Under the Biden administration’s proposal, older and/or low-income Americans with a body mass index of 30 or higher would have qualified for coverage for the drugs.
Kennedy has criticized GLP-1 medications like Ozempic in the past, claiming in interviews that these drugs are being pushed onto Americans by foreign companies who don’t sell the same product in their home countries. Kennedy has instead focused on lifestyle changes for combating obesity, though he told CNBC last year GLP-1s “have a place” in treating obesity.
The HHS secretary this week stressed cost as the biggest barrier to getting Medicaid and Medicare coverage, calling GLP-1s “extraordinary drugs.”
“I think everybody would like to make those drugs available to everybody under Medicaid and Medicare, but the impact on our medical costs would increase dramatically,” Kennedy told CBS News. “One of the estimates I saw is that the average employer in this country would end up paying double what they’re paying now for health care costs for their workers.”
Kennedy noted the GLP-1 drugs are a fraction of the cost in other countries compared to the U.S., adding, “President Trump has ordered us to get, to bring it down to, you know, something around European pricing.”
