Medicare, Medicaid plan to experiment with covering weight loss drugs

Washington Post via MSN ^ | 08/01/2025 | Paige Winfield Cunningham

[DFG]

Some obese Americans on Medicare and Medicaid could get access to expensive weight loss drugs under a five-year experiment being planned by the Trump administration.

Under the proposed plan, state Medicaid programs and Medicare Part D insurance plans would be able to voluntarily choose to cover Ozempic, Wegovy, Mounjaro and Zepbound for patients for “weight management” purposes, according to Centers for Medicare and Medicaid Services documents obtained by The Washington Post.

It’s a strong signal that the administration is open to more broadly covering GLP-1 drugs — lauded by many as a miracle solution to Americans’ long-standing struggle with weight — through government insurance programs. Medicare covers the drugs mainly for patients with Type 2 diabetes, even as some private insurance plans cover them for patients with obesity.

The experiment is expected to start in April 2026 for Medicaid and January 2027 for Medicare plans, according to the documents. It will be conducted through a testing lab called the Center for Medicare and Medicaid Innovation (CMMI), which tries new ways of paying for health care with the goal of lowering costs and improving care.

The project is an alternative way to get anti-obesity drugs to Medicare and Medicaid patients, after the administration said in April that neither program would cover GLP-1s for weight loss. In doing so, it scrapped a 2024 Biden administration proposal for the programs to start covering GLP-1s for patients with obesity.

Chiquita Brooks-LaSure, who led CMS during the Biden administration, said the experiment would be a “game changer” if it led to expanded coverage of treatments for obesity.

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TOPICS: Health/Medicine
KEYWORDS:

[DeplorablePaul]

GLP-1 drugs have received a lot of good press lately. GLP-1 is being touted as a “moderation” drug whose magic molecule bonds with receptors in various organs with good effect.

[ComputerGuy]

What part does overeating play in the overweight saga?

[DIRTYSECRET]

Not necessary. When it comes to a weight loss drug that works people will come up with the money. They can name their price.

It all has to do with getting laid.

[bk1000]

Wouldn’t it be better to limit what foods one can buy with EBT cards?

[goodnesswins]

EXACTLY! For most.

[Jubal Harshaw]

Here’s a study which quantifies the cost of these drugs per quality adjusted life year saved:

https://jamanetwork.com/journals/jama-health-forum/fullarticle/28312

Tldr: they are REALLY REALLY expensive at this time. Semaglutide costs about $467,000 per QALY benefit. Yes, thats almost half a million dollars a year.

[ridesthemiles]

HOW ABOUT REDUCING THE FOOD STAMPS BENEFITS INSTEAD????

[Vermont Lt]

I would imagine that having obese folks loose weight will be a net positive over 5 to 10 years. Fewer heart attacks, knee and hip replacements, fewer strokes, etc.

There has to be a bean counter somewhere who is doing to math.

[Jubal Harshaw]

See post 7. Yes, the math has been done.

[Vaduz]

Medicare, Medicaid (tax payer) shouldn’t be covering weight loss drugs if the have the money to get in that shape they sure as hell can pay for the meds.

Not Your Daddy

[RideForever]

GLP-1 drugs have received a lot of good press lately. GLP-1 is being touted as a “moderation” drug whose magic molecule bonds with receptors in various organs with good effect.

Any time you pay big Pharma to 'help' you, you have to give them tacit permission to kill you after they have taken your $$$. Any good effect found is offset by unexplained bad effects, like a shorter life expectancy. Rarely is this discussed by your physician unless you specifically bring it up.

[Savage Beast]

I have enormous self-discipline.

I always assumed that fat people merely lacked discipline or were too self-indulgent or had psychological problems causing them to over-eat, e.g. fear of sex.

Not true.

My metabolism changed to the extent that I became 40 lb. overweight.

My systolic blood pressure was regularly in the 140's, sometimes up to 160's. Regular antihypertensive medication brought it down into the 130's.

For years, upon arising every morning, I have weighed, naked on a physician's office scale, and taken my blood pressure, the average of six readings

I could not get the weight down despite excellent medical help, serious exercise, white-knuckle starvation, a seriously attentive wife, professional weight-loss programs, and locking the refrigerator and pantry doors. It was impossible.

My personal physician prescribed Mounjaro. My weight began dropping immediately. Over the course of three months, I easily lost 35 lbs.

Furthermore, my systolic blood pressure became normal without any medication. It is now regularly in the 120's and sometimes 115-120. Diastolic is regularly in the 60's or 70's. That's with NO antihypertensive medication.

There are side effects. My hands and feet feel disturbingly cold and unpleasant most of the time. I sometimes feel weak. I have had disturbing episodes of orthostatic hypotension.

Nevertheless, the benefits have outweighed the problems, and I am continuing, under the careful supervision of my personal physician.

[ComputerGuy]

Good luck. I can eat anything I want as much as I want, and not gain a pound.

[Flaming Conservative]

Mounjaro is for diabetics. As a wonderful side effect, it causes you to not get hungry, and lose weight. Type 2 diabetics have insulin resistance, which makes it easy to gain weight and tough to lose it

[Savage Beast]

You’re lucky. And I’m envious! I have relatives like that. I was once like that myself. Unfortunately I inherited the fat-after-30 genes.