The Centers for Medicare and Medicaid Services recently announced—without explanation—that it would not proceed with a proposal initiated by the Biden Administration to cover weight-loss drugs like Wegovy and Zepbound for its beneficiaries.
Medicare and Medicaid recipients can be reimbursed for the medications to treat diabetes, but currently the anti-obesity versions of these drugs will not be covered. As an obesity treatment, Wegovy, made by Novo Nordisk, comes with a slightly higher dose for treating obesity than doses for diabetes; the medication is otherwise the same. For Zepbound, developed by Lilly, it’s the same drug and administered in the same dose as Mounjaro, which is used to treat diabetes.
The Biden proposal would have included coverage of Wegovy and Zepbound to treat obesity under Medicare Part D for Medicare Advantage.
“While today’s announcement was limited, we hope that with the confirmation of the new CMS director, the Trump Administration will move forward to finalize the definition of obesity. It is essential that CMS regulations are aligned with current medical science—and that means recognizing obesity as a serious chronic disease,” a spokesperson from Novo Nordisk said in a statement to TIME.
A Lilly spokesperson said in a statement to TIME that the company “is disappointed in the MA-Part D rule because it is not the best reading of the statute and impacts patient access to obesity treatments,” referring to the program that allows enrollees to receive coverage of prescription drugs, including through private plans and through Medicare Advantage. “We will continue to work with the Trump Administration and Congressional leaders to ensure people living with obesity are covered by Medicare and Medicaid and are no longer left behind.”
How Weight Loss Drugs Work
The decision not to expand coverage to include obesity treatment would mean nearly 7.5 million Medicare and Medicaid recipients won’t be reimbursed for the drug to help them lose weight. Government health care financing analysts noted in Sept. 2024 that the high cost of the drugs would result in higher government spending with “little information on longer-term effects of the drugs.”
However, health experts have raised concerns that denying coverage could lead to additional health costs for insurers, as scientists are discovering that the drugs come with many other health benefits. The drugs have already received additional indications from the U.S. Food and Drug Administration to lower the risk of heart disease and obstructive sleep apnea. And researchers are currently studying them for other benefits as well, including reducing the risk of kidney, liver, and brain diseases like Alzheimer’s and addiction.
