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Ozempic, Wegovy maker lobbies Congress to get Medicare to cover its weight loss drugs

STEVE INSKEEP, HOST:

A drug company has been lobbying Congress to get Medicare to cover its weight loss drugs. Novo Nordisk makes Wegovy and Ozempic. These are very popular drugs. And aside from weight loss, the company claims they may prevent heart attacks. But many people need a lot of money to pay for the drugs. Many insurance plans do not cover them, and the company is leaning on lawmakers to get it covered under Medicare, the health care program for seniors. Rachana Pradhan from our partner KFF Health News is here to discuss this. Good morning.

RACHANA PRADHAN, BYLINE: Good to be with you, Steve. Thanks.

INSKEEP: Why doesn't Medicare cover these drugs?

PRADHAN: Well, there is an explicit ban under federal law that says that Medicare's prescription drug benefit cannot cover drugs that are used for weight loss.

INSKEEP: I'd like to understand why there would be a ban, because it does seem obvious for many people in many health situations that losing some weight will be beneficial for them. So why would the federal law explicitly forbid that kind of drug?

PRADHAN: Well, when Medicare's prescription drug benefit was created in 2003, we were living in a different time. Weight loss drugs that were on the market were not nearly as effective as the new generation of drugs that we are seeing on the market now. And at that time, it was really fresh, I think, in lawmaker's memory that there were some pretty major diet pill debacles that made lawmakers extremely skeptical about covering these drugs under Medicare.

INSKEEP: So there was this environment 20 years ago when the law was passed. Now things have changed, or Novo Nordisk would like people to think so anyway. What are they doing to try to get Congress to change this ban so that Medicare would cover their drugs?

PRADHAN: They are focused on the Congressional Black Caucus and associations that are kind of affiliated with that caucus of lawmakers to communicate their message and get allies in their pursuit of this policy goal.

INSKEEP: Does this include campaign contributions or what?

PRADHAN: Well, certainly Novo Nordisk and other pharmaceutical companies give campaign cash to lawmakers regardless of political party. But they oftentimes will sponsor panels, webinars and give to these nonprofits that are associated with these different groups of lawmakers as a way to sort of bolster their advocacy work, if you will.

INSKEEP: Is this particularly bad, though? I'm thinking about studies that find that Black Americans do have certain kinds of health problems more often than other people, and that can include problems like heart attacks and strokes and obesity.

PRADHAN: For sure. I mean, based on body mass index, the BMI, African Americans have the highest rates of obesity in the U.S. And so I think there's a reason why Novo Nordisk would want Black figures to be a part of its messaging on this. And it is true that these drugs really do have significant benefit in that the weight loss experience among patients is very significant. However, as with anything in American medicine, you can't separate costs from the benefits. And any drug, regardless of what it is, has benefits but also has risks. And so I think that that is the thing that needs to be balanced - right? - which is that you have to look at the bigger picture from all of these different factors.

INSKEEP: Rachana Pradhan of KFF Health News has been covering a lobbying effort by Novo Nordisk for its weight loss drugs. Thanks so much.

PRADHAN: Thank you. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Steve Inskeep is a host of NPR's Morning Edition, as well as NPR's morning news podcast Up First.
Rachana Pradhan