It’s Uncertain if the Trump Administration Will Finalize Rule to Expand Medicare and Medicaid Coverage for Weight Loss Drugs
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A November 2024 proposal by the Biden administration that would allow Medicare and require Medicaid (Medi-Cal in California) to provide coverage for weight loss drugs could be in jeopardy.
Until now, Medicare has been prohibited from paying for weight loss medications unless they are prescribed for treatment of diabetes or to manage a patient’s increased risk of heart disease.
Coverage of these drugs by Medicaid has been left to the states, but most have declined coverage due to potential costs.
The Centers for Medicare & Medicaid Services (CMS) change would reclassify obesity drugs as a chronic disease treatment. It would reinterpret current law and expand the drugs availability to all people with obesity. Across the federal and state programs, eight million people could be affected. Weight loss medications can cost $1,000 a month or more, without insurance or a manufacturer discount.
The CMS expansion would dramatically reduce out-of-pocket costs for patients. However, it would cost Medicare $25 billion and Medicaid another $11 billion over 10 years. States’ costs could be around $3.8 billion. At this time, there’s no expected increase in out-of-pocket premiums.
The Biden administration proposal still requires a 60-day public comment period before it can go into effect. That’s why implementation is uncertain. It’s possible the Trump administration will not follow through. Robert F. Kennedy, Jr., Trump’s nominee for Health & Human Services Secretary, has expressed skepticism about obesity drugs. Dr. Mehmet Oz, the proposed head of CMS in the new Trump administration, has a more favorable view.
In January, more than 70 patient advocacy organizations called on the Trump team to finalize the planned obesity drug expansion. However, just days into his second term, President Trump has already signed Executive Orders reversing some Biden measures on health care. Stay tuned for updates.
In related news, Eli Lilly’s CEO said this month that its new weight loss pill, Orforglipron, could be approved in 2026. It is part of a drug class known as incretins, which are designed to mimic the GLP-1 hormone. Most GLP-1 agonists are injectable medications taken once a day or once a week.