The Centers for Medicare and Medicaid Services (CMS) announced on April 4 that it would not start covering anti-obesity drugs for its beneficiaries.
This decision was reflected in a final ruling, released the same day, that sought to modernize and improve Medicare Advantage, Medicare Prescription Drug Benefits (Part D), Medicare cost plans, and Programs of All-Inclusive Care for the Elderly.
It stated that it did not intend to finalize Part D coverage of anti-obesity medications (AOMs), without elaborating further.
The Biden administration proposed a rule in November 2024 that would allow weight loss drugs like Wegovy and Zepbound to be covered by the two healthcare services, expanding access to almost 4 million Medicaid users and 3.4 million Medicare users.
Older and low-income Americans with a body mass index of 30 or higher would have qualified under the rule. It was anticipated to cost taxpayers $35 billion over the next decade, but members of Congress on both sides of the aisle said that the coverage could ultimately save billions of dollars spent on treating the chronic ailments associated with obesity.
The rule was not expected to be finalized until after President Donald Trump took office.
Weight loss drugs like Wegovy and Zepbound are GLP-1 medications, which can already be covered by Medicare when prescribed for conditions like diabetes, heart disease, and the need to reduce the risk of strokes. However, legislation passed in 2003 prohibits Medicare from covering medication directly for weight loss.
A CMS spokeswoman told The Epoch Times in an email that the agency “believes that finalizing the proposal to expand coverage of AOMs for the treatment of obesity in Medicare Part D and Medicaid is not appropriate at this time.”
“CMS may consider future policy options for AOMs pending further review of both the potential benefits of these drugs including updated clinical indications, and relevant costs including fiscal impacts on stakeholders such as state Medicaid agencies,” it stated.
This ruling comes a day after the Senate voted for Dr. Mehmet Oz to run the Centers for Medicare and Medicaid Services on a 53–45 party-line vote.
“We have a generational opportunity to fix our health care system and help people stay healthy for longer,” Oz said in his opening remarks before his Senate confirmation hearing on March 14.
Medicare and Medicaid administer health coverage payments for more than 160 million people, spending one in five taxpayer dollars through Medicare, Medicaid, the Children’s Health Insurance Program, and the Health Insurance Marketplace. Republican lawmakers hold out hope that Oz will work to improve this system.
