BBC News
BBCTrump’s nominees for top health jobs agree that Americans need to lose weight, but they disagree on whether they should provide drugs to achieve that aim – especially when those medicines are quite so expensive.
As a weight management doctor, Mollie Cecil has seen first-hand how the latest weight-loss drugs help her patients.
She knows from personal experience, too. After a year on one medication, the West Virginia doctor lost 40 pounds. Her cholesterol and arthritis improved, allowing her to be more active with her young children.
“I just felt like a new person on them,” she said.
But she worried about the same obstacle facing many of her patients – losing insurance coverage – so she tapered off the drugs as a precaution.
It turned out she was right. Dr Cecil later learned her new non-profit insurance plan could not afford to cover the cost of the drugs.
She gradually gained back most of the weight she lost.
A new weight-loss drug policy?
The latest class of weight-loss drugs – also known as GLP-1 agonists – are “the most potent weight-loss medications we have ever had”, Dr Cecil said.
“But when I can’t get them to [my patients], as a physician who really cares about taking care of people … it just feels helpless,” she said.
The new class of drugs – often not covered by private insurance – can cost $1,000 (£809) a month on average. Federal law bans Medicare from covering the drugs when used for weight loss, though they usually are covered when used to treat diabetes and cardiovascular disease. Only 13 states provide coverage under Medicaid for weight loss purposes.
To make them more accessible, then-President Joe Biden recently proposed that Medicare and Medicaid cover them, but now that will be up to President Donald Trump’s new administration.
Its weight-loss drug policy would fall to Trump’s pick for health secretary, Robert F Kennedy Jr, and Mehmet Oz, Trump’s choice to lead Medicare and Medicaid services. But this could mean a potential clash: Kennedy is a vocal critic of the weight-loss drugs while Oz is an ardent advocate.
The Trump administration did not respond to a request for comment about how it would handle the Biden administration’s proposal for Medicare – federal insurance for those 65 and older – and Medicaid – government insurance for low-income people – to cover the drugs.
Trump’s future approach remains unclear, with several people in his inner circle holding contradictory views, said Jonathan Zhang, a professor at Duke University’s Sanford School of Public Policy.
“GLP-1, Ozempic, this is a drug that has so much patient demand,” Mr Zhang said. “It’s really taken on a life of its own on social media. So the Trump administration – or any administration – faces a tonne of pressure to do something about this in the near term.”
A weight-loss drug sceptic vs a television promoter
During his presidential run last year, Kennedy made tackling the obesity epidemic a central part of his platform. Over 100 million people in the US are obese, according to the US Centers for Disease Control and Prevention.
After dropping out and endorsing Trump, Kennedy launched his “Make America Healthy Again” initiative to reduce obesity by eliminating ultra-processed foods and additives, among other more controversial ideas.
But the 71-year-old has been outspoken about weight-loss drugs, telling Fox News in October: “They’re counting on selling [weight-loss medications] to Americans because we’re so stupid and so addicted to drugs.”
“If we just gave good food, three meals a day, to every man, woman and child in our country, we could solve the obesity and diabetes epidemic overnight,” Kennedy added.
Shortly after Trump chose Kennedy to lead the Department of Health and Human Services (HHS), he announced that he selected Oz, a former TV show host and surgeon, to lead the Centers for Medicare and Medicaid (CMS), an agency within HHS that administers the government health insurance.
As a television show host, Oz spent years promoting various weight-loss drugs, including more recently, GLP-1 drugs.
“For those who want to lose a few pounds, Ozempic and other semaglutide medications can be a big help,” Oz posted on Instagram in 2023. “We need to make it as easy as possible for people to meet their health goals, period.”
Decisions about Medicare and Medicaid drug coverage would likely involve leaders from both HHS and CMS, experts said.
Spokespeople for Oz and Kennedy did not respond to requests for comment about how they would handle the policy decision. Neither has been confirmed to their appointments yet.
An ‘enormous’ cost
The high price of GLP-1 drugs – which are patented, meaning cheaper copycat versions can’t be made – has led to a debate among insurance companies, said Benjamin Rome, a health policy researcher at Harvard Medical School.
The companies have to decide whether to raise insurance premiums, in general, to cover the costs, or to forgo coverage of GLP-1s altogether, he said.
Many have decided not to cover them. Others cut off coverage to patients once they lose weight and reach a body mass index (BMI) below the obesity range of 30 or higher, Dr Cecil said.
When Dr Cecil was on a GLP-1 using her previous insurance, she said she wouldn’t allow herself to lose as much weight as she wanted to avoid crossing the BMI threshold.
“They’ll cut off coverage, saying, ‘Well, you don’t need it anymore. You’ve lost weight.’ But of course, the reason they lost weight is because of the medicine,” she said.
Getting off anti-obesity drugs too quickly also can cause unpleasant withdrawal effects, and many gain back the weight.
Government insurance faces a similar cost predicament when it comes to covering the new weight-loss medications.
“Although there’s obviously a lot of interest in doing so to make these highly effective drugs more available to patients who need them, the cost of doing so would be enormous because so many people are eligible and because the prices are so high,” Dr Rome said.
When Biden officials issued the rule requiring Medicare and Medicaid to cover the anti-obesity medications, they did so after the election, knowing it would not be up to them to carry the policy out, said Mark Fendrick, the director of the University of Michigan Center for Value-Based Insurance Design.
The federal government said last year that it could cost about $25b for Medicare and $11b for Medicaid to provide the drugs over the next 10 years.
“How do we pay for that?” Dr Fendrick asked.
The Biden-era rule must go through a public comment period before the Trump administration ultimately decides whether to move forward with it, experts said.
Dr Cecil said the government and private insurance companies may remain hesitant to foot the bill for such expensive medications.
But she believes the savings that would come from tackling obesity for millions of Americans would greatly outweigh the short-term costs.
“Five to ten years is when we would really see a huge payoff, because that’s when we would really start to see trending downwards for some of these more serious long term complications,” Dr Cecil said.
“If everyone who needed the drugs could afford them and wanted to take them, it would be pretty game changing.”
