admin Millions of Americans living with obesity could soon have access to popular weight-loss medications like Wegovy or Zepbound through Medicare or Medicaid, thanks to a new proposal announced by the Biden administration on Tuesday morning.
The ambitious and costly plan from the U.S. Department of Health and Human Services (HHS) has already sparked debate. It sets the stage for a potential conflict between the pharmaceutical industry and Robert F. Kennedy Jr., President-elect Donald Trump’s nominee to lead the agency, who has voiced strong opposition to funding such treatments.
If enacted, the proposal would offer millions access to weekly injections that have been hailed as transformative, with some dubbing them “miracle drugs.” However, the estimated price tag—up to $35 billion over the next decade—has raised questions about its financial viability.
“It’s a good day for anyone living with obesity,” U.S. Health and Human Services Secretary Xavier Becerra said in an interview with the Associated Press. “This is a game changer for Americans who otherwise cannot afford these drugs.”
The rule, if approved, would take effect in January—just days after Trump assumes office. A bipartisan coalition of lawmakers has argued that covering these drugs could save the government billions in long-term healthcare costs related to obesity-linked conditions. However, the upfront costs might deter fiscal conservatives in Trump’s administration who have prioritised reducing government spending.
Under the proposal, coverage would be limited to those classified as obese, defined as having a body mass index (BMI) of 30 or higher. While some individuals may already have access to these drugs under Medicare or Medicaid due to other conditions like diabetes or heart disease, the rule would expand eligibility significantly. Becerra estimated the change could benefit an additional 3.5 million people on Medicare and 4 million on Medicaid. However, broader estimates from the Centers for Medicare and Medicaid Services suggest that around 28 million people on Medicaid meet the criteria for obesity.
Medicare has been barred from covering weight-loss treatments under a decades-old law that excluded such products from its remit. The proposed rule would update this approach, officially recognising obesity as a disease that can be treated with medication.
The rise of anti-obesity medications has revolutionised the field in recent years. The FDA has approved a new class of weekly injectables, such as Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound, which have shown remarkable results. Patients can lose between 15% and 25% of their body weight with these drugs, which work by mimicking hormones that regulate appetite and signal feelings of fullness between the gut and brain.
However, the cost of these medications has made them accessible only to a small, wealthier demographic, including high-profile celebrities who have publicly praised their effectiveness. A month’s supply of Wegovy costs roughly $1,300, while Zepbound is priced at $1,000. Limited availability has further restricted access, with ongoing shortages impacting supply.
Kennedy, Trump’s nominee for HHS secretary, has expressed strong reservations about the widespread use of these medications. In public statements and social media posts, he has argued that the government should not cover weight-loss drugs under Medicaid or Medicare. Instead, Kennedy advocates for expanded funding for healthier food options and fitness programmes, which he views as more sustainable long-term solutions.
“For half the price of Ozempic, we could provide regeneratively raised organic food for every American—three meals a day—and offer gym memberships to every person living with obesity,” Kennedy told federal lawmakers at a roundtable earlier this year. Ozempic, another diabetes drug known for its weight-loss effects, has been a focal point of the ongoing debate.
The Biden administration’s proposal highlights the growing tension between addressing obesity as a chronic health condition and managing the economic implications of providing widespread access to high-cost treatments. As the conversation evolves, the final decision will likely have profound implications for healthcare policy and millions of Americans living with obesity.
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