“Biden administration decision bars access to drugs like Wegovy and Saxenda for millions of Americans — understand the impacts on public health and your pocketbook.”
What Happened? (Straight to the Point Context)
The Centers for Medicare and Medicaid Services (CMS) finalized the new Medicare Advantage (MA) rules this week, but dropped the most anticipated proposal: coverage of anti-obesity drugs (such as the famous GLP-1s: Wegovy, Zepbound and Saxenda) until 2026.
What was cut:
✅ Innovative drugs: Patients will continue to pay $1,000+ per month out of pocket.
✅ Protections against AI: No new rules to prevent algorithms from unfairly denying treatments.
✅ Deceptive marketing: Health insurance brokers continue to lack strict oversight.
What’s been kept:
🔹 $35/month insulin cap (starting in 2025).
🔹 Free vaccines in Medicare Part D.
Why Should You Care? (Direct Impact)
If you have obesity or diabetes:
No government help: You’ll still pay exorbitant prices for medications that reduce heart attacks and strokes.
Alternatives? Only expensive private plans or drug company discount programs.
If you’re elderly or care for someone on Medicare:
MA plans can deny hospitalizations even after initial approval (yes, that’s now allowed!).
Benefits cut: Plans will no longer be able to offer junk food or cigarettes as “perks.”
If you’re a taxpayer:
Future cost: Obesity generates $173 billion/year in medical expenses in the US. Medications could reduce that amount, but the government preferred to save now.
The Controversy (Explosive Debate)
For coverage:
“It’s a short-sighted decision. Drugs like Wegovy prevent diabetes and heart disease, saving billions in the future.” — Dr. John Smith, Endocrine Association.
Against:
“GLP-1s are too expensive for the system. We need sustainable solutions like diet and exercise.” — Robert F. Kennedy Jr., HHS Secretary.
What’s Next? (Next Steps)
Pharmaceutical pressure: Lilly and Novo Nordisk already lobbying to reverse the decision.
New rules in 2025: CMS promises to review GLP-1 inclusion, but no deadline.
Question to Readers:
“Do you think the government should cover anti-obesity drugs? Comment below!
