Evaluating the Impact of GLP-1 Obesity Drugs on Public Health and Policy

The Biden administration has proposed a plan to include costly GLP-1 obesity medications like semaglutide (Wegovy) and tirzepatide (Zepbound) in Medicare and Medicaid coverage. However, this initiative would require approval from the new Trump administration. A law passed by Congress two decades ago currently prohibits Medicare and Medicaid from covering any “weight loss” drugs. The Biden administration seeks to bypass this restriction by classifying the medications as treatments for obesity and related health complications.

Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services (CMS), emphasized that the goal is to provide access to these medications before patients develop additional related conditions. She stated, “We don’t want to see people having to wait until they have these additional diseases before they get treatment,” as reported by The New York Times. Under the proposal, all state Medicaid programs would be required to cover the cost of these drugs, which currently exceed $1,200 per month before discounts from the manufacturers.

If approved, the change could grant 3.4 million new Medicare patients and 4 million Medicaid patients access to these weight-loss treatments. However, the proposal faces a challenge: the incoming Trump administration, led by Robert F. Kennedy, Jr., appointed to head the Department of Health and Human Services, has shown skepticism toward these drugs. Kennedy has publicly stated that the obesity and diabetes crises could be solved by providing better nutrition, particularly through the distribution of healthy meals.

This stance contrasts with that of Dr. Mehmet Oz, the former television host chosen by Trump to head the CMS. Oz has been a vocal advocate for the GLP-1 medications, arguing that they are effective tools in managing obesity.

Despite political opposition, the proposal aligns with public opinion—an overwhelming 76% of older Americans support Medicare coverage for these medications, according to a University of Michigan poll.

GLP-1 medications function by mimicking a hormone in the small intestine that slows stomach emptying and promotes a feeling of fullness, which helps people eat less. Clinical evidence suggests that these drugs are effective in aiding weight loss and in reducing the risk of various chronic diseases such as diabetes, heart disease, kidney issues, fatty liver disease, arthritis, and even asthma.

However, expanding coverage for these medications would come with a hefty price tag—$25 billion for Medicare and $11 billion for Medicaid over the next decade. Still, there is optimism that the price of these medications, produced by Novo Nordisk and Eli Lilly, may decrease as the Biden administration moves forward with legislation allowing Medicare to negotiate the price of Wegovy starting in 2025.

It’s important to note that many individuals with obesity also suffer from other chronic conditions, such as diabetes or heart disease, for which Medicare and Medicaid already cover the cost of these medications. The number of obese individuals without other health conditions is relatively small.

Brooks-LaSure emphasized that a broader inclusion of Wegovy and Zepbound in Medicare and Medicaid would benefit a larger population. “Everybody deserves access,” she said. “The more friction there is in the system—the more hoops you have to meet, all these characteristics—the harder it is for people to get the care they need.”

Commentary by YourDailyFit columnist Alice Winters

The debate surrounding GLP-1 obesity medications, specifically semaglutide (Wegovy) and tirzepatide (Zepbound), offers a sharp lens through which we can examine the complexities of modern healthcare policy, drug pricing, and public health strategy. At the center of this conversation is the pressing issue of obesity, a multifaceted health crisis that has long plagued the United States and continues to escalate.

First, let’s address the core of the Biden administration’s proposal: the attempt to classify these medications not simply as weight loss drugs but as legitimate treatments for the disease of obesity and its related complications. By framing the drugs this way, the administration seeks to bypass the existing legislative restrictions that prevent Medicare and Medicaid from covering such treatments. This tactic is not without merit. The evidence supporting GLP-1 drugs in addressing not only obesity but also a range of associated health issues—including type 2 diabetes, heart disease, and fatty liver disease—is compelling. In many cases, weight loss itself can be a cornerstone for managing these chronic conditions, leading to improved outcomes for patients.

However, the financial implications of this proposal are substantial. The estimated cost to Medicare and Medicaid over the next decade—$25 billion and $11 billion, respectively—raises a fundamental question: how can the U.S. healthcare system balance the need for innovative treatments with the financial sustainability of public programs? While it’s heartening to see a policy initiative that prioritizes access to treatments that can improve quality of life, especially in a context where over 40% of Americans are obese, the long-term fiscal viability of expanding coverage for high-cost medications cannot be ignored.

Moreover, the skepticism voiced by figures such as Robert F. Kennedy, Jr. and the contrasting support from Dr. Mehmet Oz highlight the polarized views on how to address obesity. Kennedy’s argument that healthy eating, rather than pharmacological intervention, should be the focus may resonate with those who believe in the importance of preventive health measures. However, this view may underestimate the complexity of obesity as a disease that is influenced by genetic, environmental, and socio-economic factors—factors that healthy eating alone may not adequately address for many individuals.

From a market perspective, the growing popularity of GLP-1 medications—combined with the potential for price negotiations—suggests that these treatments are becoming an integral part of the weight loss landscape. Pharmaceutical companies like Novo Nordisk and Eli Lilly are positioning these drugs not just as tools for obesity management but as foundational therapies in the fight against related chronic diseases. The reality is that these drugs are not miracle solutions but rather part of a broader, multi-pronged approach to healthcare that includes lifestyle changes, medical supervision, and long-term maintenance.

The discussion about access is another critical point. Brooks-LaSure’s statement that “everybody deserves access” underscores a growing sentiment that healthcare, including life-changing medications like GLP-1s, should not be gated by bureaucratic hurdles or financial barriers. For many Americans, particularly those from lower-income backgrounds, these drugs could offer a critical path to better health outcomes. The current price point, however, remains prohibitive for many, which is why broader insurance coverage and price reduction strategies are essential if we are to make any real progress.

Ultimately, the GLP-1 debate serves as a microcosm of larger conversations surrounding public health, healthcare costs, and the role of pharmaceuticals in managing complex health issues. While the proposed changes are a step forward in making these life-saving treatments accessible to more people, careful consideration of the economic and social impacts is needed to ensure that we are not creating a new set of problems while solving the existing ones. The outcome of this policy shift will likely have far-reaching effects, not just on the healthcare system but on the lives of millions struggling with obesity and its related diseases.