Illustration: Annelise Capossela/Axios
Biden administration officials say they're getting around the congressional ban on Medicare coverage of anti-obesity medications by "reinterpretation of the statute" to view treating obesity as addressing a chronic condition rather than weight loss.
Why it matters: The administration's announcement Tuesday of a proposed rule that would allow Medicare to cover anti-obesity medications could trigger a backlash if lawmakers think the administration is going beyond its authority.
- The proposed rule would also require Medicaid programs to cover anti-obesity medications. They're currently covered only as an optional benefit, and coverage varies by state.
What they're saying: "During my time as CMS administrator, I have heard from countless people about how this coverage exclusion is a barrier preventing people from treating obesity and living healthier lives," CMS administrator Chiquita Brooks-LaSure said Tuesday in a call with reporters.
- "That's why we're proposing to revise our interpretation of the law and provide coverage of anti-obesity medications for the treatment of obesity, and give millions of people a just opportunity to get the care they need."
By the numbers: The officials said they estimate about 3.4 million people in the Medicare program and 4 million in Medicaid would become newly eligible for obesity treatment.
- Over 10 years, they estimated this new prescription drug coverage would cost $25 billion to the Medicare program, compared with $2.1 trillion total spending on Medicare Part D.
- For Medicaid, the cost over 10 years would be split between $11 billion covered by the federal government and $3.8 billion by states.
Yes, but: The proposed rule could be reversed or altered by the incoming Trump administration.
What we're watching: At least one lawmaker had protested the move as of Tuesday morning: Rep. Lloyd Doggett, ranking member of the Ways and Means health subcommittee. So we're watching to see if others will join in.
- "Compelling Medicare and Medicaid to offer medications, whose prices they cannot now negotiate, will only bloat spending — costing taxpayers billions, raising premiums, and threatening the long-term security and promise of Medicare," Doggett said in a statement.
