The Trump administration has rejected a proposal to expand Medicare and Medicaid coverage for weight loss drugs such as Wegovy and Zepbound.
Originally, the Biden administration had hoped to classify obesity as a chronic disease to provide patients with medication access. However, the Trump administration thinks differently, reversing the decision. Consequently, the move has caused a heated national debate.
GLP-1 Drugs and Obesity
Initially, GLP-1 medications were developed to treat type 2 diabetes. Over time, researchers discovered their powerful effects on weight loss. In fact, some clinical trials showed participants lost up to 20% of their body weight. As a result, the Biden administration moved in late 2024 to include these medications under Medicare Part D.
At the time, US citizens saw the move as a landmark shift toward modernizing obesity care. Nevertheless, many critics argued the costs would far outweigh the benefits.
Medicare Plan Rejected
Last week, the Centers for Medicare and Medicaid Services (CMS) announced the cancellation of the Biden-era plan. Speicifically, CMS stated that Medicare’s current rules, which prohibit weight loss drug coverage, would stay in place.
Furthermore, the announcement coincided with the confirmation of Dr. Mehmet Oz as the new CMS Administrator. Correspondingly, Health and Human Services Secretary Robert F. Kennedy, Jr. emphasized a greater focus on lifestyle and prevention, rather than pharmaceutical solutions.
Notably, the administration framed the decision as protecting taxpayers from ballooning healthcare costs. Yet public health advocates warned of long-term risks associated with untreated obesity.
Financial & Policy Considerations
CMS officials estimated the coverage expansion would cost around $40 billion over the next decade. Therefore, the Trump administration cited fiscal responsibility as a major reason for scrapping the proposal.
Still, others pointed out that lifestyle changes alone have rarely solved America’s growing obesity epidemic. Critics argue the administration’s move ignored scientific advances.
Reactions to Non-Medicare Coverage
Predictably, pharmaceutical companies like Eli Lilly and Novo Nordisk expressed disappointment. Although disappointed, they vowed to continue working with the Trump administration and Congress to push for obesity drugs coverage.
Meanwhile, polls show a majority of Americans support Medicare and Medicaid coverage for weight loss drugs. However, without federal backing, patients will continue facing high out-of-pocket costs for these medications.
Encouragingly, more than a dozen state Medicaid programs already cover GLP-1 medications for obesity. Thus, some patients may still find access at the state level.
Future Implications
While the decision may be disappointing for drugmakers, the CMS says it is not entirely a dead end.
“CMS may consider future policy options for AOMs pending further review of both the potential benefits of these drugs including updated clinical indications, and relevant costs including fiscal impacts on stakeholders such as state Medicaid agencies,” a spokesperson told CBS News.
For now, healthcare experts warn that the state-based coverage system could deepen existing healthcare inequalities. Consequently, patients in states without expanded coverage would be left behind.
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