On April 4, 2025, the Centers for Medicare & Medicaid Services (CMS) confirmed it will not expand coverage of weight-loss medications under Medicare beginning in 2026. The decision marks a significant shift away from a prior proposal under the Biden administration and reflects a focus on fiscal responsibility and traditional health interventions.

Medicare Coverage Will Remain Limited to Diabetes Treatment

Currently, Medicare only covers glucagon-like peptide-1 receptor agonists (GLP-1RAs), such as Ozempic and Mounjaro, when prescribed for type 2 diabetes. The rejected proposal would have extended coverage to include prescriptions for obesity alone, impacting drugs like Wegovy and Zepbound.

Had the proposal moved forward, it could have expanded access to as many as 3.4 million adults, according to estimates by the Biden administration. However, CMS under the Trump administration opted not to finalize that policy.

Medicaid coverage for these drugs remains a state-level decision. While some states have chosen to include weight-loss medications, the majority still do not.

Payers Support CMS Decision

Ceci Connolly, CEO of the Alliance of Community Health Plans (ACHP), voiced support for the CMS ruling, citing high costs and a lack of long-term studies.

“While these drugs offer hope for many, the excessive costs carry enormous consequences for consumers, taxpayers, and employers,” Connolly said in an April 4 statement.  She also stated that “(the expansion) Would have been irresponsible without further long-term efficacy and safety studies and economic analysis.”

Despite industry pressure to expand Medicare drug coverage, payer groups and policy analysts raised concerns about the long-term cost and effectiveness of such medications.

A Conservative Approach to Public Health

The Trump administration emphasized tackling obesity through non-pharmaceutical methods, aligning with its broader Make America Healthy Again initiative. Health and Human Services Secretary Robert F. Kennedy Jr. echoed that sentiment during his Senate confirmation hearing in January 2025.

“The GLP class of drugs are miracle drugs, but I do not think they should be the first, front-line intervention for six-year-old kids,” Kennedy said.

While the medications have shown promise for weight loss, many experts agree that more research is needed on their long-term health effects and economic impact.

Looking Ahead

CMS’s choice to exclude weight-loss drugs from Medicare coverage in 2026 underscores the importance of conservative, fiscally sound healthcare planning. While pharmaceutical advances show promise, prioritizing lifestyle changes, prevention, and targeted treatment remains essential.

AMAC members are encouraged to stay informed, support traditional health approaches, and advocate for policies that protect both seniors and taxpayers.

For help with Medicare drug plans – or any questions you may have about Medicare – contact AMAC’s Medicare Advisory Service at 1-855-611-4856 or request a quote here.