Legislation that would make Medicare cover blockbuster weight-loss drugs took its first step forward today when House Ways and Means overwhelmingly voted to advance the Treat and Reduce Obesity Act, Victoria reports.
Why it matters: Although TROA has been introduced every Congress for the last decade, it hadn't been marked up until today, when the committee signaled broad bipartisan support with a 36–4 vote.
Yes, but: Key to the bill's approval was a chairman's amendment limiting coverage to people who are diagnosed as obese and who have been taking the drugs at least one year before enrolling in Medicare.
- The narrower criteria will almost certainly reduce the CBO score and ease concern about drugs like Wegovy and Zepbound putting a financial strain on the program. W&M health staff director Patrick Dumas said the pared-down bill was estimated to cost $1.7 billion over 10 years.
- The committee rejected a Democratic attempt to broaden criteria and allow all Medicare beneficiaries to access weight-loss drugs.
Zoom in: It remains to be seen whether the bill will receive a floor vote, but it's a priority for Rep. Brad Wenstrup, a longtime cosponsor who's retiring at the end of this Congress and is close to Majority Leader Steve Scalise.
Driving the news: Committee Democrats during the markup debated whether the bill would benefit only certain groups and isn't equitable.
- Rep. Lloyd Doggett raised the specter of only wealthy individuals who've accessed the drugs on generous private health plans being able to have costs covered by Medicare.
- Rep. Gwen Moore countered that individuals on Medicaid who similarly are already taking the drugs would also gain Medicare coverage.
- Rep. Don Beyer also said that getting Wegovy and Zepbound into the Medicare system was a good way to start lowering the prices of the drugs by making them eligible for Medicare drug price negotiations.
The committee advanced other health bills that would extend Medicare coverage for medical devices approved under the FDA's Breakthrough Devices Programs, to multi-cancer early detection screening tests, and to add a cognitive impairment detection benefit.
