News Briefs: CMS Proposes Rule Expanding Medicare, Medicaid Coverage of Anti-Obesity Drugs
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Nov 26, 2024
CMS in a proposed rule issued Nov. 26 included a provision that would significantly expand Medicare and Medicaid beneficiaries’ access to anti-obesity medications. Currently, Medicare does not cover FDA-approved weight loss medications such as Wegovy (semaglutide) or Zepbound (tirzepatide), but it does cover those drugs when used to treat diabetes under the brand names Ozempic and Mounjaro, respectively. Under the newly proposed rule, CMS is proposing to reinterpret the Medicare statute, starting in 2026, “to no longer exclude anti-obesity medications for the treatment of obesity from coverage under Medicare Part D and to require Medicaid programs to cover these medications when used to treat obesity,” CMS said. Just 13 state Medicaid programs covered GLP-1s like Wegovy and Zepbound for treating obesity as of August 2024, according to KFF. The Congressional Budget Office estimated in October that authorizing Medicare to cover anti-obesity medications would increase federal spending, on net, by about $35 billion from 2026 to 2034. But CMS estimated that, if implemented, the new proposal would increase federal costs by $24.8 billion due to expanded Part D coverage and $14.8 billion due to expanded Medicaid coverage, over a 10-year period. Read more
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