For more than two decades, Medicare has maintained a prohibition on covering weight loss drugs, effectively denying access to potentially beneficial treatments for millions of Americans. This restriction has become increasingly problematic with the approval of potent yet expensive medications like Wegovy and Zepbound by the Food and Drug Administration (FDA), rendering them financially inaccessible for all but the wealthiest individuals.

In a significant development, the House Ways and Means Committee made strides towards overturning this long-standing ban by advancing the legislation known as The Treat and Reduce Obesity Act of 2023 to the full House floor. This legislative move, after languishing in Congress for over a decade without a committee vote, marks a critical opportunity to potentially expand Medicare coverage to include weight loss drugs.

Despite clearing the committee hurdle, the bill's path forward remains uncertain. It must now navigate the full House, where its passage is not assured. Subsequently, it will require Senate approval and the president's signature before becoming law—a process that must conclude by January 3, 2025, the end of the current Congressional session.

Juliette Cubanski, deputy director of the program on Medicare policy at KFF, highlighted the challenges ahead, stating, "This is the first step of a path that is still very uncertain. There’s probably a lot of other things on the congressional agenda that they want to get done."

The revised version of the bill approved by the committee imposes eligibility restrictions, limiting coverage to individuals who have used weight loss drugs for at least a year prior to enrolling in Medicare. This approach specifically targets those diagnosed with obesity, excluding overweight individuals with weight-related conditions, despite FDA guidelines allowing medications for both groups.

During committee discussions, Rep. Judy Chu (D-CA) voiced disappointment over the bill's narrowed scope, concerned that many seniors may still lack access to these medications. Committee chair Jason Smith (R-MO) acknowledged these concerns, emphasizing the urgency of action after years of legislative stagnation: "This bill has been around since 2013. If we wait for perfect here, we’ll wait for another 11 years."

Financial considerations have heavily influenced the bill's current form, particularly concerns over the potential budget impact of Medicare covering costly drugs like Wegovy and Zepbound. Cubanski underscored the importance of affordability measures, cautioning, "It seems there’s a desire to find a way to make this more affordable. I think it would be concerning if all people get out of this is coverage for a very limited number of people."

Meanwhile, Senator Bernie Sanders (I-VT) has intensified public pressure on Novo Nordisk, the manufacturer of Ozempic and Wegovy, to lower drug prices. In response, Novo Nordisk's CEO has agreed to testify before the Senate Committee on Health, Education, Labor and Pensions in September, addressing concerns over the accessibility and affordability of these widely used weight loss medications.

As stakeholders monitor the legislative process, the fate of The Treat and Reduce Obesity Act of 2023 holds significant implications for reshaping access to weight loss treatments among Medicare beneficiaries, amidst navigating complex fiscal and policy challenges.