Novo Nordisk, the maker of the weight loss drug Wegovy and diabetes medication Ozempic, went on a federal lobbying spending spree in the first six months of 2023.

The Danish drugmaker is pushing Congress to pass a bill that would nix Medicare restrictions on covering weight management treatments.

Novo Nordisk has hired three new lobbying firms over the past three months, all of which disclosed being solely focused on issues related to obesity and Medicare coverage of anti-obesity drugs.

A 2003 law excludes weight-loss drugs from coverage under Medicare, the federal program that provides health coverage for older Americans. But since the American Medical Association recognized obesity as a disease in 2013, momentum has been building to shift federal policy.

“When Congress created the Medicare Part D drug benefit in 2003 the medical community’s understanding of obesity was in its infancy,” Nicole Ferreira, senior manager of corporate communications at Novo Nordisk, told The Hill in a written statement.

“Since then, the science has advanced, and we have learned obesity is a chronic, treatable disease — not simply a behavioral issue,” Ferreira wrote.

Sens. Tom Carper (D-Del.) and Bill Cassidy (R-La.) and Reps. Raul Ruiz (D-Calif.) and Brad Wenstrup (R-Ohio) reintroduced the Treat and Reduce Obesity Act, which would expand coverage of weight management medication to qualifying Medicare beneficiaries, before the August recess.

Novo Nordisk lobbies up

While the Treat and Reduce Obesity Act has stalled each time it’s been reintroduced over the past decade, drugmakers are capitalizing on several new factors to plead their case.

Public demand for the weight-loss drug is high, and initial clinical trials recently suggested Wegovy reduces the risk of serious heart problems.

Qualifying federal employees are also now eligible for anti-obesity medication coverage, the U.S. Office of Personnel Management clarified in January.

“We recognize the progress made in covering anti-obesity medications; our goal is to have all Carriers offer adequate coverage,” the guidance reads.

In the first half of the year, Novo Nordisk spent nearly $2.9 million on federal lobbying for a range of policy issues including obesity drug coverage and the Treat and Reduce Obesity Act, according to federal lobbying data analyzed by OpenSecrets, the research group that tracks money in politics.

There are more lobbyists than ever on the Novo Nordisk payroll.

Sixty-three lobbyists, 44 of whom have swung through the so-called “revolving door” between the private sector and the government, registered to lobby on behalf of the drug maker in the first half of 2023, according to OpenSecrets data.

Novo Nordisk had 50 total lobbyists in 2022 and 28 in 2019.

Since the end of June, two new lobbying firms registered three new lobbyists to work on issues related to obesity on behalf of Novo Nordisk.

One of the new lobbyists is Bill Ghent, a member of the Subject Matters government relations team and former chief of staff to Carper, the bill’s lead sponsor. Ghent was Carper’s legislative director when the senator first introduced the bill in 2012. 

Ghent did not return The Hill’s request for comment.

Shortages, cost concerns could derail momentum

Questions of cost and supply constraints are clouding the hype surrounding these new drugs.

The demand has not only made it harder for people to access the anti-obesity drug, but also for patients with diabetes to access the medication they need.

Wegovy and Ozempic are both injections that contain semaglutide, with the dosage per pen and regulator-approved uses differentiating the drugs.

The Food and Drug Administration (FDA) approved Ozempic to treat type 2 diabetes in 2017, and the higher-dose Wegovy for weight loss in 2021.

Although Ozempic has not been approved for weight loss, it’s sometimes prescribed off-label — meaning for a purpose outside the one approved by the FDA — as demand for weight loss drugs soars. But off label usage is often not covered by insurers.

Demand for the drug has also outpaced supply, leading the FDA to note that Wegovy and Ozempic semaglutide injections are “currently in shortage.”

“We understand how frustrating this situation is for the communities we serve and appreciate everyone’s patience as we continue to navigate significant demand for Wegovy,” Ferreira said.

“Please know that our commitment to the obesity community is a long-term one and we are investing significantly to build capacity to meet this increasing demand.”

Could Medicare coverage help pricing?

It’s unclear how expanded Medicare coverage would impact already-high demand.

There’s also an ongoing debate on the cost of covering anti-obesity treatments, as the Congressional Budget Office has yet to officially score the Treat and Reduce Obesity Act.

Researchers at Vanderbilt University Medical Center estimated that covering new anti-obesity medications for just 10 percent of Medicare beneficiaries could cost the federal program up to $26.8 billion per year and drive up premiums for drug plans.

But a study by the USC Schaeffer Center for Health Policy and Economics found Medicare coverage for obesity treatments could generate up to $245 billion in savings in the first 10 years, in part due to reducing comorbidities associated with obesity, including heart attack and stroke.

“We’ve had to talk about things as so black-and-white, as either don’t cover it at all or give it to everybody, and I think that there is a middle ground,” Alison Sexton Ward, a research scientist with a doctorate in applied economics who worked on the study, told The Hill in an interview.

“A lot of this conversation is being lost by the list price,” Ward added.

Wegovy is prohibitively expensive without insurance, with the list price topping $1,300 per month. While most patients won’t pay the full list price after rebates or insurance, prices are up to 10 times higher in the U.S. than in other peer nations, a recent analysis by KFF found.

Many rebates also only apply to users who actually have diabetes.

“Novo Nordisk believes the most effective way for the millions of Americans who need anti-obesity medicines to be able to access and afford them is to ensure these medicines are covered by government and commercial insurance plans,” Ferreira said.

Health trade groups rally behind bill

A constellation of organizations including the American Diabetes Association (ADA), Weight Watchers and the Obesity Action Coalition are backing the bill.

“The ADA urges swift Congressional passage of this legislation so older Americans can access the services and treatment to reduce their risk for obesity and diabetes and improve their health,” said Lisa Murdock, the ADA’s chief advocacy officer, in a written statement.

The National Kidney Foundation, American Gastroenterological Association (AGA) and Academy of Nutrition and Dietetics are among the bill’s supporters that reported lobbying work on the bill during the first half of 2023, ahead of its reintroduction.

“Because many private insurance companies model their health benefits to reflect Medicare, the passage of the bipartisan TROA could lead to improved obesity care options for all Americans,” Dr. Rotonya Carr, chairwoman of the AGA Government Affairs Committee, told The Hill in a written statement.

“The AGA fully supports this legislation and has no reservations about expanding obesity care coverage to the millions of Americans who suffer with obesity and its complications,” Carr wrote.

Notably, the pharmaceutical industry association PhRMA has not taken a position or lobbied on the bill.

“We appreciate the focus on helping seniors access the medicines they need. As the treatment paradigm for diseases and conditions advance, it’s critical to ensure Medicare coverage policies evolve as well,” PhRMA spokesperson Nicole Longo told The Hill.