Marissa Plescia , 2025-04-08 21:57:00
Late last week, the Trump administration’s CMS announced that it is not finalizing a provision proposed by the Biden administration that would expand coverage of anti-obesity drugs under Medicare and Medicaid.
Currently, Medicare and Medicaid are required to cover GLP-1s like Ozempic and Wegovy for conditions like diabetes, but Medicare is prohibited from covering them for weight loss and only some state Medicaid programs do. The proposed rule released in November would have expanded coverage to obesity as well.
The Trump administration’s decision left some healthcare leaders disappointed, including Millicent Gorham, CEO of the Alliance for Women’s Health & Prevention, a women’s health advocacy organization. Last year, the organization launched a campaign called EveryBODY Covered, which aims to expand coverage of obesity care.
“We are deeply disappointed by CMS’ decision not to finalize the proposed rule to expand coverage of obesity management medications under Medicare Part D and Medicaid,” Gorham said in a statement. “Obesity is a chronic, yet treatable, disease that has a significant impact on Americans—and particularly American women — throughout their lives. This change would have been transformative for the millions of individuals living with obesity who rely on these programs to access needed care, and would have helped to lessen the impact of the over 200 other health complications associated with the disease.”
An executive from Vida Health argued that this decision to not cover weight loss drugs for obesity shows that there is more work to be done in recognizing obesity as a “debilitating disease.” Vida Health is a digital company treating chronic conditions.
“When responsibly prescribed and included in a broader program that addresses nutrition and lifestyle, these medications play a critical role in weight loss and managing chronic conditions,” said Veeneta Lakhani, chief strategy and development officer of Vida Health, in an email. “This decision limits access to GLP-1s for many patients who would benefit, which furthers existing health disparities and inequality in obesity care.”
Another healthcare executive pointed out that GLP-1s are covered for comorbidities often associated with obesity, such as sleep apnea and cardiovascular disease, but not for the root cause itself. She argues that these medications should be covered for obesity as well as these comorbidities.
“We need to start treating obesity as the serious chronic disease that it is, rather than treating the secondary diseases that are brought on by it. Zepbound is only covered if you suffer from sleep apnea, and Wegovy is only covered if you have cardiovascular disease – but to get to the root of both issues, we need to be able to treat the underlying cause, which affects nearly half of the American population,” said Dr. Angela Fitch, chief medical officer and co-founder of weight care company knownwell, in an email.
Currently, more than 42% of adults in the U.S. have obesity. Without insurance, the cost of weight loss drugs can range from a few hundred dollars to $1,500 per month.
It’s possible that CMS will reconsider covering these drugs in the future, according to a blog post from the Medicare Policy Initiative. There have also been other proposals to expand coverage of anti-obesity medications, including bills in Congress. It’s worth noting, however, that Robert F. Kennedy Jr., secretary of the U.S. Department of Health and Human Services, has been critical of weight-loss drugs in the past and has instead stressed the importance of lifestyle changes.
Photo: Jason Dean, Getty Images