Medicare Advantage Final Rule Excludes Anti-Obesity Drug Coverage for Medicare and Medicaid” ###

The Centers for Medicare & Medicaid Services (CMS) announced that it will not finalize a Biden-era proposal to expand coverage for anti-obesity medications (AOMs) such as GLP-1 receptor agonists under Medicare Part D and Medicaid1 7.
Medicare and Medicaid are statutorily barred from covering drugs used for weight loss unless prescribed for other conditions, such as diabetes or cardiovascular disease5 8.
The Biden administration's earlier proposal sought to reinterpret this exclusion by recognizing obesity as a chronic disease and allowing coverage of AOMs for obesity under Medicare and Medicaid1 7 9.
Expanding coverage was projected to cost $40 billion over a decade, including $25 billion for Medicare and $14.8 billion for Medicaid (shared by federal and state governments)4 7.
The Trump administration decided that finalizing this proposal was inappropriate at the current time, citing fiscal concerns and the burden on Medicaid state budgets1 4.
Thirteen states currently offer optional Medicaid coverage of GLP-1 drugs for obesity treatment, which is limited and often accompanied by restrictions like prior authorization or BMI thresholds2 9.
Medicare beneficiaries with obesity, roughly 22% of enrollees as of 2022, must pay out-of-pocket for weight loss drugs due to high non-coverage rates, with medications like Wegovy priced over $1,300 per month1 7.
Critics argue that maintaining existing policies limits access for many individuals, while proponents of exclusion highlight concerns about costs and the lack of evidence linking these drugs to long-term health savings6 7.