Obesity Drug Coverage, Extra Formulary Checks Cut From Final Part D Rule
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Apr 10, 2025
In a move cheered by health insurers, President Donald Trump’s administration said on April 4 that it decided not to implement the part of a proposed rule that would have significantly expanded Medicare and Medicaid coverage of weight-loss medications. But whether the administration will ever reconsider its stance is anyone’s guess, experts say.
In its proposed Medicare Advantage and Part D rule for the 2026 contract year, issued in November 2024, former President Joe Biden’s administration sought to reinterpret the Social Security Act’s longstanding, statutory Part D coverage exclusion of drugs “used for anorexia, weight loss, or weight gain.” In doing so, drugs used to treat obesity — like the GLP-1 Wegovy (semaglutide) — would then have to be covered by Medicaid.
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