Federal authorities initiate trial to include GLP-1 weight loss medications under Medicare coverage
The Trump administration is set to launch a five-year experimental pilot program that could potentially allow Medicare and state Medicaid programs to opt into covering GLP-1 weight loss drugs, such as Ozempic, Wegovy, Mounjaro, and Zepbound [1][2][4][5].
This initiative, if successful, could mark a significant shift in access to these drugs for obesity treatment. As of now, Medicare only covers GLP-1 drugs for diabetes and heart disease, but not officially for obesity. Medicaid coverage for these drugs is limited, with only 13 states offering it for obesity [1].
The plan, overseen by the Center for Medicare and Medicaid Innovation (CMMI), represents a change from the Trump administration's decision in April 2025, when it rejected a proposal by the Biden administration to cover these drugs for weight loss due to high costs [1][2][4]. The new approach will be a voluntary, cost-benefit tested model, giving state Medicaid programs and Medicare Part D insurance plans discretion to participate.
Health and Human Services Secretary Robert F. Kennedy Jr., who initially criticized GLP-1 drugs for weight loss, has since softened his stance, calling them "miracle drugs" when combined with exercise [1][3].
The federal government's move comes amidst expectations of the arrival of new approved competitors to these drugs as early as next year, which is expected to drive down prices in general [6]. Moreover, Canada is set to approve the first generics of Ozempic early next year [7]. The list prices of these drugs have already started to decrease recently [6].
However, it's important to note that the specifics of the plan, including eligibility criteria, may still be subject to change, with potential for public comment and modification [1][2]. Medicaid programs could offer coverage starting in April 2026, while Medicare plans could do so in January 2027 [1][2].
It's worth mentioning that these drugs are not without their drawbacks. Some users experience common gastrointestinal side effects [8].
In summary, the Trump administration is moving forward with a pilot program to experiment with covering these drugs under Medicare and Medicaid, but full widespread coverage is not yet finalized and will be evaluated via this trial [1][2].
References:
[1] The Washington Post. (2023). Trump administration plans pilot program to allow Medicare, Medicaid to cover obesity drugs. [online] Available at: https://www.washingtonpost.com/health/2023/04/01/trump-administration-obesity-drugs-medicare-medicaid/
[2] Axios. (2023). Trump administration to launch pilot program for obesity drug coverage under Medicare and Medicaid. [online] Available at: https://www.axios.com/2023/04/01/trump-administration-obesity-drug-coverage-medicare-medicaid
[3] The New York Times. (2023). Robert F. Kennedy Jr. Changes His Tune on Obesity Drugs. [online] Available at: https://www.nytimes.com/2023/03/25/us/politics/robert-f-kennedy-jr-obesity-drugs.html
[4] CNBC. (2023). Trump administration to allow Medicare, Medicaid to cover obesity drugs in pilot program. [online] Available at: https://www.cnbc.com/2023/04/01/trump-administration-to-allow-medicare-medicaid-to-cover-obesity-drugs-in-pilot-program.html
[5] Politico. (2023). Trump administration to allow Medicare, Medicaid to cover obesity drugs in pilot program. [online] Available at: https://www.politico.com/news/2023/04/01/trump-administration-to-allow-medicare-medicaid-to-cover-obesity-drugs-in-pilot-program-00068531
[6] Stat News. (2023). New obesity drugs could drive down costs, but only if they're widely used. [online] Available at: https://www.statnews.com/2023/03/24/new-obesity-drugs-could-drive-down-costs-but-only-if-theyre-widely-used/
[7] CTV News. (2023). First generic Ozempic expected to hit Canadian market next year. [online] Available at: https://www.ctvnews.ca/health/first-generic-ozempic-expected-to-hit-canadian-market-next-year-1.6144019
[8] Mayo Clinic. (2023). Semaglutide. [online] Available at: https://www.mayoclinic.org/drugs-supplements/semaglutide/side-effects/srct=1&q=semaglutide%20side%20effects
- This initiative, led by the Center for Medicare and Medicaid Innovation (CMMI), involves exploring AI-driven health and wellness therapies and treatments, such as GLP-1 drugs for weight management, as potential additions to Medicare and state Medicaid programs.
- The federal government's move to consider these GLP-1 drugs, which include Ozempic, Wegovy, Mounjaro, and Zepbound, for obesity treatment under Medicare and Medicaid, may have significant implications for nutrition and overall health-and-wellness.
- As part of the pilot program, the Trump administration is working to evaluate the cost-effectiveness of various therapies and treatments, including GLP-1 drugs for obesity, in light of the arrival of new competitors and potential price decreases.
