The CMS last month declined to include anti-obesity medications in its Medicare coverage for Part D, a move that Lilly says could interfere with patients getting the appropriate medical care.
Eli Lilly in an open letter on Wednesday called out the Centers for Medicare and Medicaid Services for cutting off access to obesity drugs, in an example of what it called “coverage dictating health care providers’ and patients’ decisions regarding obesity management.”
“We don’t believe this is right,” Lilly wrote. “In an environment where people with obesity often struggle to access obesity management medications, these abrupt changes only make things more difficult.”
The open letter is in response to CMS’s final ruling last month for Medicare Advantage and Part D coverage in 2026 that conspicuously left out weight-loss treatments like Lilly’s Zepbound and Novo Nordisk’s Wegovy. The new CMS rules will be applicable to coverage starting Jan. 1, 2026.
“Medicare doesn’t cover any obesity management medications, and only a handful of states provide coverage for Medicaid patients,” Lilly wrote. In turn, these “payer-driven” choices “undermine a health care provider’s ability to choose the most appropriate treatments,” disrupting care not only for patients with obesity but also those suffering from related conditions, such as sleep apnea.
Medicare Part D has always refused to cover drugs that are explicitly indicated for weight-loss—a rule that drugmakers have tried to circumvent by expanding the labels of their drugs to include conditions the program does cover. For instance, Lilly developed Zepbound as a treatment for obstructive sleep apnea, for which it won the FDA’s approval in December 2024. Just a few weeks later, the CMS granted Zepbound coverage for this indication. Novo has similarly pursued cardiovascular risk indications for Wegovy.
In November 2024, however, the Biden administration proposed a rule that would allow Medicare Part D to cover anti-obesity treatments without pushing drugmakers to go through this regulatory maneuvering. According to a fact sheet released at the time, the move would “recognize obesity to be a chronic disease based on changes in medical consensus” and would “ensure more Americans have access to these medications.”
Even as the CMS’ 2026 ruling leaves anti-obesity medications on the outside, it does not completely shut the door. Last month, a spokesperson for the agency noted that giving these drugs coverage “is not appropriate at this time,” but that the agency “may consider future policy options” depending on the cost-benefit balance of these obesity drugs.
The mention of cost is notable, especially since covering anti-obesity therapies could add to federal spending. According to an October 2024 report from the Congressional Budget Office, placing these drugs under Medicare coverage could cost around $35 billion from 2026 to 2034. Total savings from this coverage, in terms of improved patient health, on the other hand, “would be small,” as per the CBO report.
