The Centers for Medicare and Medicaid Services (CMS) have announced that medications such as Zepbound and Wegovy will not be covered under Medicare’s Part D prescription drug program, which primarily serves individuals aged 65 and older. This decision comes following President Joe Biden’s proposal to expand coverage for these drugs, a rule that was not expected to be finalized before the end of the Trump administration. Currently, Medicare covers GLP-1 medications like Mounjaro and Ozempic for conditions such as diabetes but does not cover their versions specifically approved for obesity treatment. Injectable weight-loss treatments have become popular, but many payers are hesitant to cover them due to their high cost and the potential for a large number of users.
President Biden’s proposal aimed to expand coverage for obesity treatments through state and federally funded Medicaid programs for low-income individuals, with an estimated cost of up to $35 billion over the next decade. Supporters argue that covering these treatments could save money in the long run by preventing costly health issues associated with obesity. Some state Medicaid programs already cover these drugs, but U.S. Health Secretary Robert F. Kennedy Jr. has emphasized the importance of promoting healthy eating habits rather than relying solely on medication to address obesity.
Drug companies like Lilly and Novo Nordisk have expressed disappointment in the decision not to cover obesity treatments under Medicare and Medicaid. They believe that these medications are essential for treating obesity as a serious chronic disease, and hope that CMS regulations will align with current medical science. Analysts suggest that dropping the proposal was not surprising given the current negotiations surrounding pharmaceutical tariffs and the administration’s focus on getting concessions.
In addition to the decision on obesity treatments, CMS has also announced that two other proposals will not move forward. One proposal aimed to require Medicare providers to evaluate their healthcare utilization policies through a health equity lens, while the other was focused on establishing safeguards around the use of artificial intelligence tools in healthcare. These decisions come as concerns grow about the implications of using AI to deny or delay patient care. The future of these proposals and the broader implications of CMS’s decisions will continue to be a topic of interest and discussion in the healthcare industry.
