ฝัง
- เผยแพร่เมื่อ 29 พ.ย. 2024
- In this special breaking news episode of The Downsized, Christopher and Laraine Durham discuss President Biden’s groundbreaking proposal to expand Medicare and Medicaid coverage to include GLP-1 medications like Wegovy, Zepbound, and others used to treat the disease of obesity.
This proposal could give millions of Americans access to life-changing medications, addressing obesity as a chronic disease rather than a lifestyle issue. We also explore what this means for the future of healthcare, the challenges posed by high costs, and the political hurdles it may face as the new administration takes office.
💡 Key Topics Covered:
What Biden’s proposal includes
How Medicare and Medicaid expansion could transform obesity treatment
Insights into the political and financial challenges ahead
Why GLP-1 medications are critical tools in battling obesity
📢 Don’t forget to LIKE, SUBSCRIBE, and hit the notification bell so you never miss an update. Together, we can advocate for better treatment options for those of us battling the disease of obesity.
Join us LIVE tonight at 7:00 PM for more updates and discussions!
#GLP1 #Wegovy #Zepbound #Medicare #Medicaid #ObesityTreatment #BreakingNews #TheDownsized
Thank you for being willing to talk about how politicians affect our health care and medication coverage. I am afraid of President Elect Trump getting rid of the affordable care act as he has stated multiple times. The affordable care act got rid of prexisiting conditions. If the ACA goes away obesity and diabetes will no longer be covered because they will be considered pre existing conditions. We need to be vocal to our government and new administration about what we need!
Very true.
Yep we’re in trouble if the ACA goes away. He didn’t do it last time, I hope it doesn’t happen this time.
He and the GOP tried VERY hard to repeal the ACA last time, and very nearly succeeded in doing so. 😧
They fell short of repeal by ONE VOTE in the Senate. Just one☝️
@@cloakster And there are no more John McCains around to stop him.
:(
I'd be happy if people on Medicare could at least use the coupon! Doesn't make sense to exclude us!
Agreed!
Mochi just announced a tirzepatide price cut! $199 for all doses.
For what it's worth, I highly expect that up to 60% of the new administration uses glp1 agonists. This is more of a bipartisan cause than you may rea!ize. If the supply is strained, due to Medicare coverage, compounding will continue. RFK will get a lot of feedback from his conservative fans on this, I guarantee.
CD: I firmly believe treating the disease of obesity is bipartisan and far larger than any political party. The question is whether their usage will translate into policy and law.
@@thedownsized- we need to make sure our voices are heard. Success is the best way to influence people and policy.
My daughter is on Medicaid and I am on Medicare so we are both paying OOP. We both have numerous co-morbidities but the guidelines are currently so narrow that we are forced out. Something needs to change!
Great episode! Thank you!
Glad you enjoyed it!
Even if Medicare accepts GLP-1, the problem is consumers have to find a part D coverage that will offer an affordable cost. There’s a WSJ article le today about PBMs and how the negotiations for drugs fluctuates greatly by region and Part D PBMs. Unless that’s fixed patients may find no relief in out of pocket cost. Not to mention the disparity in what Americans pay vs other countries for the same medicine. I tried comparison shopping for my Nexlezit, cholesterol medicine. It’s a tier 5 drug, and 90 day supply is $1400. My part D covers $700, the lowest price I could get was ordering through India! It was a non branded copy for $200. I chose to remain with branded.
I suspect GLP drugs will be a tier 5 too unless other brands or generics can be made.
CD: it remains to be seen what the details are and how it is implemented You could well be right.
🎉Congrats on your success, and thank you for the info🎉
Our pleasure!
Hopefully, this goes through. The health benefits will save so much for our future health needs.
I don’t think the angle is that GLP1s will save insurance companies money because it decreases the need for other medications because a lot of the other meds are relatively inexpensive. I think the angle is the decrease in
hospital admissions and stays that GLP1s will result in-- that’s what costs them an arm and a leg.
CD: Both are part of the potential cost savings as well as the corresponding healthcare services form the numerous comorbidities
Absolutely!
I now get Ozempic through my German public health system, for only 10 euros for 3 1.0 pens. Prior to that, an American doctor prescribed it and I paid out of pocket (in Germany), about 80 euros per month. So it's considerably cheaper in Germany! It would be awesome if these drugs would be covered in the US.
I don’t have a problem with that, but I’m not eligible for Medicare or Medicaid, and I pay lots of taxes. Seems it should also be mandatory for insurance coverages to provide coverage for everyone who needs it. It will save money over the long term.
CD: we are not eligible for medicaid or medicare either. But i am happy to have our taxes contribute to healthcare and paying for this medication will make this country healthier. The hope is that medicate and medicaid policies are often the first steps to broad insurance acceptance.
@@thedownsizedagreed!!
@@thedownsized - that would be wonderful!
School house rock!! 🎉😂❤ I'm just a bill, Laraine, I just love you! I remember that too and it would certainly help now!!
….and I’m sittin here on Capitol Hill 🤩❤️
Love ❤both of you!!! So informative
Thanks so much!!
Always appreciate hopeful news🎉
They should, instead, consider some kind of coverage for compounded medications. ALL of them, not just GLP-1.
I believe this would force costs down. All covering certain drugs does is make big pharma bigger. I think that is the real issue. It’s not political.
There are alot of options for change. but it will take think and doing different
Thank you for keeping us informed! Enjoying your channel and content! ❤
You are so welcome!
Regarding dx of diabetes, my insurance is paying for Ozempic for DM2 (will not cover wegovy or zepbound) BUT my NP had to send in information to show other meds had been tried and failed before approving glp1 for diabetes, but not obesity.
A friend of mine with DM2 and overweight as well, on Medicaid, would love to get on glp1 but Medicaid won’t approve hers for the same reason. Metformin has helped to bring her A1c down, so won’t cover glp1 for the diabetes or weight.
I'm in Michigan and have 2 family members on Medicaid and both are on wegovy and are fully covered by Medicaid.
Thank you so much for the info guys
Can Biden do an executive order to have Medicare start covering GLP1 or does Congress have to act on it?
It would not technically be a executive order.
The Biden administration is proposing to reinterpret the law barring coverage by classifying obesity drugs as treatment for a "chronic disease," rather than as weight loss medications.
"The medical community today agrees that obesity is a chronic disease," Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure said on a call with reporters Tuesday. "These drugs are the beginning of a revolution in the way that weight is controlled."
Sesame does not prescribe compound weight loss drugs. I left them because of this and joined Mochi.
according to their site they do sell compounded semaglutide sesamecare.com/service/online-weight-loss-program
I feel once a month would be too much med at one time. When they came out with a 6 month shot for heartworm prevention for dogs aka one shot every six months …so many dogs died. It was just too much medication all at once and taken off the market, obviously this is different, but it just scares me. I feel with the GLP if you have a reaction you’re screwed for a month. What if you need unexpected surgery, I rather do weekly shots, jmo 🤷🏻♀️
CD: We will look at the research deeper - my initial pass saw that the tolerability was better than the weekly
Even if Biden does push this through and Trump agrees to keep it, it won’t take effect until sometime in 2026.
Best case scenario is that it comes in on January 1;2026. That is still 13 months away.
I would not be getting too excited.
Glass half full, Gab. 👍
@@cloakster Absolutely but I am also a realist as you know. I think these drugs should be covered by America and Australia’s Medicare systems. I’d put it in the water like flouride if I could.
The great things it is doing for gambling and alcohol addiction in addition to obesity is wonderful.
And if it can help dementia patients that would be such a marvellous thing for so many families.
I just hate the way politicians of all persuasions announce things with such huge lead times that will only be done when they are out of office or could be out of office.
Our govt here does it every election season. They promise things but only if they are voted in for an another term.
I think America and the world is in for an awful time come 20 Jan when the orange man gets in. I fear especially for the Ukrainians and the Palestinians. The tariffs will sink America further in the eyes of the rest of the world which is not good for stability.
Too late now. The Americans have spoken and voted in who they wanted which is right in a democracy. The world just remembers what happened last time he was in, even if the majority of Americans have forgotten.
CD: there is nothing to push through, this is not new law it is a reinterpretation of existing law. yes it will be 2026 but hope is a good thing.
Hi all, the LillyDirect vials are $399 for 2.5 mg and $549 for 5.0 mg. The price for 5.0 is not far off from the coupon price. I believe they could have done Much better with pricing the vials. Big media blitz without a huge difference in cost.
thanks mel
That’s good but compounded formulas are half or a third that cost depending on if you’re getting script from your dr or going thru telegraph. My compounded semaglutide is $150/mo thru my PCP. Using vials.
I really think the 2.5 mg should be no more than $150
It’s a huge cost savings (using the Lilly vials) if you can’t use the savings card, and are thus staring at a $1000+ monthly bill otherwise. 😱
2026?
Theoretically
Seems like whatever he proposes won’t matter much once the clown car arrives, good luck everybody!
You’re so right. ❤
🤡🚗🤣