In a surprising reversal, the Centers for Medicare and Medicaid Services (CMS) has quietly declined to move forward with a Biden-era proposal that would have allowed coverage of powerful weight-loss drugs like Wegovy and Zepbound for Medicare beneficiaries.
The decision comes without public explanation and leaves an estimated 7.5 million Americans enrolled in Medicare and Medicaid without coverage for these groundbreaking anti-obesity treatments, despite growing evidence of their broader health benefits.
Currently, these drugs—developed by Novo Nordisk and Eli Lilly—are reimbursable under Medicare only when prescribed for Type 2 diabetes. This is despite the fact that medications like Wegovy (a higher-dose version of Ozempic) and Zepbound (identical in formulation and dosage to Mounjaro) have been approved by the FDA for obesity treatment. The proposed rule would have added them to the list of reimbursable drugs under Medicare Part D and Medicare Advantage.
Pharmaceutical companies have expressed frustration over the CMS decision. “It is essential that CMS regulations align with modern science—and that includes recognizing obesity as a chronic disease,” a Novo Nordisk spokesperson said in a statement. Eli Lilly echoed that sentiment, stating it was “disappointed” and vowing to work with the current administration and Congress to push for broader access.
The CMS decision also highlights a conflict between short-term cost control and long-term health investment. Analysts have cited the high price tag of GLP-1 drugs—often thousands of dollars per month—as a deterrent to public coverage, warning of increased government spending with limited long-term data.
However, medical experts argue that denying coverage could prove costlier in the long run. The new class of GLP-1 drugs has shown potential not only in weight loss but in reducing risks for cardiovascular disease, obstructive sleep apnea, and possibly even neurodegenerative conditions like Alzheimer’s. Some experts believe these medications may be on track to redefine chronic disease management as a whole.
Still, for now, millions of Medicare and Medicaid patients living with obesity will remain excluded from accessing these treatments—despite mounting scientific support for their effectiveness.
The decision underscores a growing tension in the healthcare system: balancing immediate budget concerns with transformative advancements in medical science. And until that balance is struck, access to potentially life-changing obesity treatments remains limited to those who can afford to pay out of pocket.