The Trump administration is preparing a five-year test that could allow some Medicare and Medicaid patients to access high-profile weight loss drugs, including Ozempic, Wegovy, Mounjaro, and Zepbound. The plan, which would let state Medicaid programs and Medicare Part D insurers choose to cover these drugs for obesity treatment, represents a potential shift in federal policy, reports the Washington Post. Currently, Medicare usually only covers these medications for diabetes, while their use for weight management has been a sticking point for private insurers.
The experiment, slated to begin in April 2026 for Medicaid and January 2027 for Medicare, will run through the Center for Medicare and Medicaid Innovation, a group tasked with finding cost-effective health solutions. It would require participating programs to pair the drugs with lifestyle coaching for diet and exercise. The proposal follows the administration's recent decision to drop plans for blanket coverage of these drugs for obesity, a move that reversed a Biden-era proposal from last year.
The debate is heated: While some health officials call wider access a "game changer," others, including Health Secretary Robert F. Kennedy Jr., worry about the high price tags and urge people to focus on traditional weight management. The Guardian notes that some friction might even exist on the matter between RFK Jr. and Dr. Mehmet Oz, the administrator for the Centers for Medicare and Medicaid Services who has offered his praise for weight loss drugs in the past.
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At $5,000 to $7,000 a year per patient, broad coverage could cost Medicare an estimated $35 billion over eight years. Skeptics point to concerns about weight regain after stopping the drugs—which have been shown in trials to slash body weight by up to 20%, per Reuters—and insurers warn of the program's financial risks. State interest is uncertain: Only 13 have opted in so far, with many wary of losing federal Medicaid funds.
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