Earlier this year, the Centers for Medicare and Medicaid Services scrapped a previous proposal, from the Biden administration, to include anti-obesity medications in Medicare Part D coverage.
The Centers for Medicare and Medicaid Services is reportedly considering coverage of GLP-1 drugs for weight management and obesity, reviving a Biden-era proposal the Trump administration scrapped earlier this year.
The proposed coverage program, originally reported by The Washington Post on Friday, would involve a five-year pilot where individual state Medicaid and Medicare Part D plans can voluntarily opt to cover Novo Nordisk’s semaglutide brands Ozempic and Wegovy or Eli Lilly’s tirzepatide drugs Mounjaro and Zepbound.
According to CMS documents viewed by the publication, these drugs can be covered for “weight management” purposes, as per The Washington Post.
When asked by The Washington Post about the reported pilot, a CMS spokeswoman said that “all drug coverages undergo a cost-benefit review. CMS does not comment on potential models or coverage.” Still, former CMS administrator Chiquita Brooks-LaSure told the publication that the proposed program could be a “game changer” for patients if it led to wider changes in coverage.
This represents a reversal from the Trump administration’s previous stance on covering GLP-1s. In November 2024, the Biden administration’s CMS came out with a proposal to include the drugs under Medicare Part D, a move that the agency at the time said would “recognize obesity to be a chronic disease based on changes in medical consensus,” according to a fact sheet for the proposal.
In April, however, CMS reversed course under President Donald Trump and released a final ruling that left the coverage proposal for obesity drugs on the cutting room floor. “CMS is not finalizing certain provisions from the proposed rule,” the agency wrote at the time, with a spokesperson however noting days later that CMS “may consider future policy options” for anti-obesity drugs.
“CMS may consider future policy options for [anti-obesity medications] 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,” the spokesperson said.
“We don’t believe this is right,” Eli Lilly wrote in May, blasting CMS’s decision to leave obesity coverage out of its final ruling. “In an environment where people with obesity often struggle to access obesity management medications, these abrupt changes only make things more difficult,” the pharma added.
Lilly has circumvented CMS’s refusal to cover drugs for obesity by tacking on additional indications to its drugs, including sleep apnea, for which Zepbound was approved in December 2024 and granted CMS coverage weeks later. Fellow obesity leader Novo Nordisk has taken a similar approach and in March 2024 snagged Medicare coverage for Wegovy for the reduction of the risk of heart attack, stroke and other related cardiovascular issues in patients who have preexisting heart disease. Wegovy was approved for this indication that same month.
