WASHINGTON — A House committee overwhelmingly passed four bills on Thursday that would expand Medicare coverage of obesity drugs and cancer screening blood tests and place guardrails around Medicare’s discretion in covering drugs and devices approved by the Food and Drug Administration.
The House Ways & Means Committee passed obesity drug coverage legislation that would offer a limited pathway for adults 65 and older to get their weight loss drugs paid for by Medicare. Right now, Medicare is prohibited from covering medications used for weight loss, like Wegovy and Zepbound.
However, the new plan is significantly more restrictive than prior proposals. It’s primarily targeted at making sure that people currently taking weight loss drugs don’t get kicked off when they enter the Medicare program, such as by turning 65.
“Without this bill, seniors will face the choice of losing access to these drugs or paying thousands out of pocket. Future taxpayers will then foot the bill for health services that were preventable,” Ways & Means Chair Jason Smith (R-Mo.) said.
While the bill overwhelmingly passed 36-4 on a bipartisan basis, two of the no votes came from the top Democrat on the broader committee, Rep. Richard Neal (D-Mass.), and the panel’s health subcommittee ranking member, Rep. Lloyd Doggett (D-Texas).
Neal’s primary concern was that the bill only provides coverage for people who had an insurance plan that covered weight loss drugs before they entered Medicare, which could disadvantage patients with less generous plans.
“I am concerned about turning Medicare into haves for those with good private insurance, and have-nots for those who don’t. The rationing under this bill doesn’t align with our goal of unlocking access regardless of wealth.”
Another bill that gained even more support would expand Medicare coverage of cancer screening. The legislation passed on a 38-0 vote.
Medicare is allowed to pay for FDA-approved tests that diagnose diseases, but it doesn’t cover tests that simply screen healthy people for cancer. The bill would open the door for Medicare to pay for cancer screening tests, including Grail’s Galleri.
The bill has heavy bipartisan support, but it’s been thwarted by the expected high cost to Medicare, which could eventually run into the tens of billions of dollars. However, the Congressional Budget Office projects costs for 10 years into the future, so the committee changed the bill to push much of its cost after that 10-year period. They did so by delaying the start date for covering cancer screening tests and phasing Medicare coverage in by age groups. Starting in 2028, seniors younger than 68 would be eligible for coverage. The coverage age would increase by one year each subsequent year.
Galleri and many other tests that screen for multiple types of cancer at once are not yet FDA approved. Currently, Galleri has a list price of about $950, which patients pay for out of their own pockets. The bill would direct Medicare to pay $508 for multi-cancer screening tests.
The committee also voted on a bill concerning Medicare coverage of innovative medical devices. Device makers have complained for years about the gap between approval from the Food and Drug Administration and securing coverage from CMS, which typically leads the way for private insurers. Most devices stuck in this limbo are in the FDA’s breakthrough devices program, meant to speed up patient access to novel, potentially lifesaving treatments. So far, the program has primarily benefited companies by boosting investor interest.
A group of bipartisan representatives introduced the bill last year, proposing four years of temporary Medicare coverage for all breakthrough devices. But Democrats are concerned the bill erodes CMS’ power to protect patients from unnecessary or unsafe medical devices.
“I appreciate the efforts to improve the breakthrough technology bill, but it still overrides Medicare’s ability to safeguard beneficiaries, and that should be unacceptable,” Neal said.
The new version of the bill introduced Thursday addresses some of these concerns, giving CMS the explicit authority to decide which device to give temporary coverage instead of a blanket rule for all breakthrough devices. CMS would only consider devices with data from clinical trials that enrolled people eligible for Medicare. The bill would also give CMS $10 million each year to dedicate to the program, and a mandate to make the temporary coverage decision no more than six months after FDA approval.
The bill passed on a 36-5 vote.
At the same time, device makers are waiting on the final version of a CMS rule for covering breakthrough devices proposed last June. Industry leaders were disappointed by the limited scope of the rule, which allowed for only five covered devices per year. It’s unclear when the final rule is coming, though a CMS representative told attendees at an April event that the agency was shooting for early summer.
Scott Whitaker, president and CEO of the medical device lobby AdvaMed, called the bill “a major step forward,” but called for diagnostic tests to be included as well.
Another bill that passed unanimously would, among other things, force Medicare to reconsider special coverage decisions after 10 years. Currently, a new class of Alzheimer’s drugs is covered under this process.