On April 4, the Trump Administration announced that Medicare and Medicaid will not cover anti-obesity drugs, including the GLP-1 class of medications.
Historically, Medicare is barred by statute from covering weight loss drugs, but as part of the 2026 proposed rule for Medicare Part D prescription plans, the Biden Administration planned to allow coverage of these drugs to all people with obesity on Medicare or Medicaid.
The Trump Administration did not provide details regarding their decision, which was published in the 2026 Medicare Part D Final rule, other than stating that the proposal “is not appropriate at this time.” Currently, Medicare Part D plans cover GLP-1 drugs for type 2 diabetes, sleep apnea, and to prevent heart complications, and it is expected to continue to do so.
However, ACG expects continued interest in GLP-1 medications from both the administration and Congress.
To date, HHS leadership have sent mixed signals on the issue. HHS Secretary Robert F. Kennedy has criticized the drugs, while Mehmet Oz, MD, Administrator of the Centers for Medicare and Medicaid Services, has praised the benefits of the treatments.
On April 15, five Senate Democrats sent a letter to Secretary Kennedy, urging the administration to re-issue the rule and focusing on the long-term benefits of managing co-morbidities and health complications.
In addition, the United States Preventive Services Task Force (USPSTF) is developing a draft recommendation statement on whether weight-loss interventions affect health outcomes such as cardiovascular disease. Such a recommendation could provide a pathway for private insurers to provide coverage – though the upcoming Supreme Court case about the USPSTF may complicate matters.
What would Medicare coverage of anti-obesity medicines cost?
In October 2024, the Congressional Budget Office (CBO) analyzed the impact of the proposed change to cover anti-obesity medications.
The report found:
- Covering GLP-1 drugs for obesity would cost Medicare $35 billion from 2026 to 2034
- Cost-savings would be minimal, totaling $3.4 billion from 2026 to 2034
- More than two-thirds of Medicare beneficiaries can be classified as ‘obese’ (34%) or ‘overweight’ (35%);
- 28% of Medicare beneficiaries classified as ‘obese’ have type 2 diabetes, as well as an additional 16% for those classified as ‘overweight’; even among Medicare beneficiaries who are not classified as ‘overweight’ or ‘obese’, 83% have weight-related chronic conditions (heart conditions and certain cancers)
The CBO also cited challenges in their analysis, including (1) the rapid evolution of real-world clinical data on GLP-1 impact and effectiveness and (2) the difficulty of assessing whether weight-loss alone would reverse the weight-related chronic conditions, as well as any associated cost savings.
These clinical questions provide ACG members with a good opportunity to educate and collaborate with policymakers tasked with reviewing potential coverage of GLP-1 medications in the future.