Medicare-Covered Ozempic and Long-Term Care Would Be Very Pricey
It’s no surprise that campaigning for office is largely a matter of buying votes with unrealistic promises of largesse to be funded—if the promise is ever fulfilled—on the backs of those to be named later. As befits a particularly awful election season, 2024 features some true doozies when it comes to pie-in-the-sky promises. But among them are new schemes to relieve people of covering their own healthcare costs by having Medicare pick up the tab for weight loss drugs and in-home, long-term care.
Drugs That Cure Obesity—at a Price
With 41.9 percent of Americans adults obese, according to the Centers for Disease Control, Ozempic, Wegovy and other GLP-1 weight loss drugs have soared in popularity. As many as one in eight Americans have tried these drugs, which promise to succeed where dieting, exercise, and willpower often fail. And, in fact, obesity rates do appear to have turned a corner, dipping down after years of the population getting ever more massive. Weight loss drugs may have made the difference.
But nothing comes without a cost, and the price tag for these drugs is substantial. “A monthly supply of Ozempic costs almost $1,000 before discounts or rebates,” Bloomberg reported in May. That said, those discounts and rebates can make a big difference in a medical system where prices are as slippery as those in a Middle Eastern bazaar. A 2023 paper by the American Enterprise Institute found that for weight-loss drugs, “net prices received by drugmakers are 48–78 percent lower than list prices.”
Still, there’s no bargain like having the tab picked up by Uncle Sugar (even if that just moves it over to everybody’s tax bill). And that’s exactly what federal lawmakers facing the voters have in mind.
“Should the legislation become law, the implications could extend beyond seniors,” claimed the office of Rep. Paul Ruiz (D–Calif.) as he announced the bipartisan Treat and Reduce Obesity Act with other lawmakers, including Rep. Brad Wenstrup, (R–Ohio). “Medicare coverage might prod other health insurers to pay for weight-loss medications, as private health plans tend to follow Medicare’s lead.”
As that statement suggest, the legislation—which currently has 117 cosponsors—would extend Medicare coverage to weight loss drugs, something currently prohibited.
That’s not to say that Medicare isn’t already paying for Ozempic. This class of drugs was developed to treat type 2 diabetes, and Medicare covers it for that use. In March, coverage was extended to use of the drugs for cardiovascular issues. And off-label use of drugs is common. Earlier this year, KFF, which covers health issues, reported that “Medicare spending on the three newest versions of these diabetes medications that have also been recently approved for weight loss—Ozempic, Rybelsus, and Mounjaro—
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