Under a new proposal by the Biden administration, millions of Americans could gain access to anti-obesity medications through Medicare and Medicaid. The initiative, announced Tuesday, aims to provide coverage for costly drugs that have historically been out of reach for many due to their high price.
If approved, the rule would enable 3.4 million Medicare beneficiaries and 4 million Medicaid recipients to access these medications, which can cost uninsured individuals up to $1,000 per month. Medicare enrollees may see their out-of-pocket costs for these drugs decrease by as much as 95%.
The Centers for Medicare and Medicaid Services (CMS) is proposing to reinterpret the law to classify obesity as a chronic disease, which would allow Medicare to cover anti-obesity medications. Medicaid programs would also be required to include these treatments under the new rule. The expanded coverage would begin in 2026 and apply only to those diagnosed with obesity, excluding individuals who are overweight.
“Obesity is now recognized as a chronic disease that significantly increases the risk of conditions such as heart disease, stroke, and diabetes,” said CMS Administrator Chiquita Brooks-LaSure. Currently, 22% of Medicare enrollees have obesity, a figure that has more than doubled over the past decade. Nationally, around 40% of adults are classified as obese.
The proposed Medicare expansion is projected to cost $25 billion over the next decade, while Medicaid coverage would add $11 billion to federal expenses and $3.8 billion to state budgets. Despite these costs, the administration believes expanded access will promote healthier lifestyles and reduce overall healthcare expenditures.
Medications like Wegovy and Zepbound, which fall under the GLP-1 category of drugs, are currently among the most effective but expensive treatments for obesity. The CMS has already begun covering Wegovy for some Medicare recipients diagnosed with cardiovascular disease who are obese or overweight. This approval, combined with the proposed policy change, could lead to broader adoption of similar medications.
However, challenges remain. Only 13 states currently provide Medicaid coverage for GLP-1 medications for obesity, with many others citing concerns over cost. Among private insurance plans, 18% of large employers currently cover these drugs, while a quarter are considering adding coverage in the near future.
Whether the proposal will be finalized remains uncertain, as it could face delays or opposition under future administrations. Still, advocates see the initiative as a critical step toward addressing obesity as a chronic health issue and improving access to transformative treatments for millions of Americans.