Will Medicare and Medicaid Cover Obesity Drugs?

Although the Trump administration shot down a Biden-era proposal that would have required Medicare to cover obesity medications, lawmakers have introduced legislation that would accomplish basically the same thing.

The Treat and Reduce Obesity Act of 2023 has been introduced in both the House and Senate by bipartisan groups of sponsors. The bill would allow Medicare coverage of obesity medications approved by the FDA and coverage of visits with healthcare providers who specialize in obesity treatment. Approving such a measure would have “tremendous value for both the patient and the healthcare system,” says Alison Sexton Ward, Ph.D., a research scientist at the Leonard D. Schaeffer Center for Health Policy & Economics at the University of Southern California.

The Trump administration hasn’t completely shut the door on coverage of weight loss drugs. The Washington Post has reported that the administration is considering a program that would allow state Medicaid plans and Medicare Part D plans to cover the drugs. The program would be run by the CMS’ Center for Medicare and Medicaid Innovation, the part of CMS that tests payment and delivery models on a pilot basis.

Obesity is the most common chronic disease, affecting 40% of adults. “The challenge gets worse as you age,” says Joe Nadglowski, president and chief executive officer of the Obesity Action Coalition, a nonprofit group that is supported in part by pharmaceutical companies. Nadglowski adds that “the issue is personal to me. I have the lived experience. We need all options.”

Medicare currently covers the glucagon-like peptide-1 (GLP-1) drugs only to treat conditions such as diabetes and cardiovascular disease. Broadening the access to GLP-1 medications to include the treatment of obesity could improve, delay or prevent such conditions, Sexton Ward said.

Potential savings

A study co-authored by Sexton Ward and published as a preprint on medRxiv found that expanded access to GLP-1 medications would yield up to $245 billion in savings for Medicare Part A and Part B over 10 years by reducing the demand for other services. Sexton Ward and her colleagues also found that broader access to GLP-1s would yield social returns, such as longer life expectancy and fewer years living with chronic conditions. “This makes GLP-1s one of the most effective public health investments available,” they wrote.

But a big stumbling block is the cost of such medications. The list price of the GLP-1s is roughly $1,000 a month. A study issued by the Congressional Budget Office in October found that allowing Medicare to cover GLP-1s for weight loss would increase federal spending by about $35 billion from 2026 to 2034. If Medicare did begin to cover the medications for weight loss, it could have an even broader impact. “What Medicare does, the Affordable Care Act and private insurance often follow,” notes Nadglowski.

But insurance companies aren’t keen on the prospect of covering such medications. AHIP, the health insurance industry trade association, shared a letter it sent to the CMS in January, before the Trump administration nixed the plan to increase GLP-1 coverage. The law that created Medicare Part D drug coverage explicitly prohibits Medicare from covering weight loss drugs. By reversing course, “CMS would engage in this dramatic reinterpretation without Congressional authorization, while efforts to mandate coverage through legislation have been considered but have been unsuccessful to date,” AHIP wrote. Coverage of weight loss drugs would “place upward pressure on premiums and government costs,” the association wrote, and if required, would need to be accompanied by other changes, such as an update to the Part D risk adjustment system. The association added that it welcomed the opportunity to work with the administration in exploring options to address chronic conditions, including those linked to obesity.

HHS Secretary Robert F. Kennedy Jr. has sent mixed signals on the use of obesity medications. “We are still trying to understand the secretary’s view on the issue,” Nadglowski says. In an April 2025 interview with CBS, Kennedy spoke about the possibility of beneficiaries getting coverage of GLP-1s after they tried other ways of losing weight. Republican Sen. Bill Cassidy of Louisiana, a physician and co-sponsor of the obesity legislation, said in a press release that “obesity shortens your life. We have an opportunity to treat it through Medicare. Let’s do it.”

Previous versions of the legislation have failed to make it through Congress, but Sexton Ward said that “each year I’m more hopeful than the year past.”