Capito, Justice weigh in on Biden proposal
CHARLESTON — A proposal floated Tuesday by outgoing President Joe Biden to require Medicare and Medicaid to offer coverage for prescriptions of popular but expensive injectable weight loss drugs had the tentative support of West Virginia’s soon-to-be senior senator and the state’s incoming junior senator.
The White House announced Tuesday that Biden would propose a new rule to expand coverage of anti-obesity medications — such as Ozempic and Wegovy — through Medicare and Medicaid.
Currently, Medicare and Medicaid only cover the costs of these medications for specific diagnoses, such as type 2 diabetes.
“Today’s new proposal would expand access to these innovative medications for obesity, which is widely recognized as a disease and help an estimated 3.4 million Americans with Medicare,” according to a fact sheet released by the Biden administration Tuesday. “Medicare coverage would reduce out-of-pocket costs for these prescription drugs by as much as 95 percent for some enrollees.
“Approximately 4 million adult Medicaid enrollees would also gain new access to these medications,” the fact sheet continued. “This proposal would allow Americans and their doctors to determine the best path forward so they can lead healthier lives, without worrying about their ability to cover these drugs out-of-pocket, and ultimately reduce health care costs to our nation.”
Commonly referred to as GLP-1 drugs, these injectable weekly anti-obesity drugs help manage blood sugar levels, slow digestion, and help manage hunger. According to the Cleveland Clinic, the first GLP-1 drugs were approved in 2005 and were first used to treat type 2 diabetes. But in recent years, doctors have been prescribing GLP-1 drugs without a diabetes diagnosis for weight loss, though lifestyle changes – such as diet, portion control, and exercise — are still required for long-term weight loss.
Kelley Moore, a spokesperson for U.S. Sen. Shelley Moore Capito, R-W.Va., released a statement Tuesday afternoon stating that Capito was supportive of the proposal.
“Senator Capito has long supported the idea of covering anti-obesity medications,” Moore said. “She looks forward to reviewing this proposal and working with the incoming Trump administration to create policies that lead to healthy communities.”
Speaking Tuesday afternoon during his weekly administration briefing at the State Capitol Building prior to a long Thanksgiving break for state employees, Justice said he was using Ozempic to try to help him lose weight.
“I am a recipient right now of Ozempic, and I’m trying every way that I can to lose weight,” Justice said. “I’ve been able to lose 30 or 40 pounds, maybe even 50 pounds.”
According to the Kaiser Family Foundation, GLP-1 drugs can cost as much as $1,000 for a monthly supply. These GLP-1 drugs are already causing strain on private health insurance plans, with several plans in the Affordable Care Act marketplace requiring prior authorization before being prescribed. The use of these drugs is also driving recent premium increase proposals for the Public Employees Insurance Agency (PEIA).
Despite the high cost of GLP-1 drugs, Justice said he believes that making the drugs more readily available through Medicare and Medicaid could help lower future health care costs as more and more people begin to lose weight and embrace healthier lifestyles.
“For all I know about these drugs, they are beneficial in many different ways,” Justice said. “The net-net of the whole thing is at the end of the rainbow, it’ll save us money…I would be a proponent of trying to do everything we can to be able to expand these drugs…to everybody.
“The battleground will be the cost,” Justice continued. “How are we going to handle the cost? And there’ll surely be arguments about the health benefits, but I don’t think you can argue that much. There’s too much research about that and it’s all good stuff.”
However, Justice said he believes that Biden should wait to implement the new GLP-1 rule and allow the incoming administration of former President Donald Trump to review the proposal and decide whether to implement it or not.
“I do have a problem with going ahead now because this is going to take some real work and real research and how we’re going to handle the cost,” Justice said. “What are we going to do? Can we get the cost down from the drug producers? There’s so many different avenues and different ways to go.”