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For more than two decades, a law has prohibited Medicare from paying for weight loss drugs, cutting off access to millions of potential patients who could stand to benefit. 
The ban has come into even sharper relief in recent years, with the Food and Drug Administration’s approval of powerful but pricey drugs including Wegovy and Zepbound, which, without insurance coverage, are unaffordable to all but the wealthiest members of society. 
On Thursday, a House committee took some of the first steps needed to change that law, which would allow Medicare to cover weight loss drugs for the first time. The Ways and Means Committee voted a piece of legislation called The Treat and Reduce Obesity Act of 2023 out of the committee and into the full House. 
The vote marked a pivotal moment for the bill, which has languished for over a decade in Congress. It’s been reintroduced several times, but has never come up for a committee vote as it did Thursday.
The legislation will now make its way to the full House, though it remains unclear whether it can garner enough votes for passage.
Even if it clears the House, it would still need to pass the Senate and garner the president’s endorsement to become law. Time is of the essence: The current session of Congress will end on Jan. 3, 2025. Any bills not signed into law by that time will need to be reintroduced when the next Congress convenes, essentially starting the process over. 
“This is the first step of a path that is still very uncertain,” said Juliette Cubanski, deputy director of the program on Medicare policy at KFF, a nonprofit group that researches health policy issues. “There’s probably a lot of other things on the congressional agenda that they want to get done,” she said.
In March, the federal government said Medicare will provide coverage for Wegovy. However, the coverage is limited to patients with an increased risk of heart attack, stroke or other serious cardiovascular problems. 
The legislation the Ways and Means Committee voted on Thursday was a scaled-back version of the original version of The Treat and Reduce Obesity Act.  This version would limit coverage to people who had been taking a weight loss drug for a year prior to enrolling in Medicare. The coverage would also only apply to people with obesity, excluding those who are overweight with at least one weight-related condition. (Currently, the FDA says weight loss medications can be prescribed to both groups.) 
The new version of the bill would also make changes to how intensive behavioral therapy — a treatment approach that offers patients counseling on nutrition and exercise, but doesn’t include weight loss drugs — is covered. 
“While this is a positive first step, I’m disappointed that the pared-down version of this bill drastically reduces the number of seniors that will be covered to access these medicines,” Rep. Judy Chu, D-Ca., said during a discussion before the vote.
Committee chair Jason Smith, R-Mo., said he understood the disappointment, adding that he would eventually like to see broader coverage for the weight loss drugs.
“This bill has been around since 2013,” Smith said. “If we wait for perfect here, we’ll wait for another 11 years.”
Cubanski said it appears the changes to the bill were intended to make it more financially appealing to lawmakers. 
A monthly supply of Wegovy or Zepboud can cost more than $1,000. The Congressional Budget Office has previously warned that if Medicare were to cover weight loss medications, the net cost to the program “would be significant over the next 10 years.”
“It seems that there’s a desire to find a way to make this more affordable,” Cubanski said. “I think it would be concerning if all people get out of this is coverage for a very limited number of people.” 
Meanwhile, Sen. Bernie Sanders, I-Vt., the chair of the Senate Committee on Health, Education, Labor and Pensions, is leading a public pressure campaign to force Novo Nordisk, the maker of Ozempic and Wegovy, to lower the cost of its medications.
Earlier this month, the committee announced that Novo Nordisk CEO Lars Fruergaard Jørgensen has agreed to testify in September over the pricing of the drugmaker’s hugely popular weight loss drugs.
Berkeley Lovelace Jr. is a health and medical reporter for NBC News. He covers the Food and Drug Administration, with a special focus on Covid vaccines, prescription drug pricing and health care. He previously covered the biotech and pharmaceutical industry with CNBC.