White House proposes Medicare and Medicaid coverage of Wegovy and Zepbound for obesity

The Biden administration proposed on Nov. 26, 2024, that Medicare and Medicaid cover the weight-loss drugs Wegovy and Zepbound for obesity, by reinterpreting a law that currently stops Medicare from paying for the medicines when obesity is the only reason they are prescribed ^[1].

Medicare already covers both drugs — Wegovy, made by Novo Nordisk, and Zepbound, made by Eli Lilly — to treat diabetes and heart disease, but not for obesity alone, because the law prohibits it ^[1]. Under the proposal, officials at the Centers for Medicare and Medicaid Services would reinterpret that law so coverage could reach all people with obesity in Medicare and Medicaid, the White House said ^[1].

The proposal was a proposed rule, not a final one, and its future was uncertain from the day it was announced. The Biden administration began the process late enough that the incoming Trump administration would have to finalize the rule for it to take effect ^[1]. At the time, it was not known how the new administration would view the idea: "It's unclear how the incoming Trump administration, which would have to finalize the rule, will view it" ^[1].

STAT described the move as a "major expansion" of how the two programs cover the drugs, and reported that the timing was "precarious, given the Biden administration waited so long to start the policymaking process that the incoming Trump administration would have to finalize it" ^[1]. The shift came too late for President Biden or Vice President Harris to benefit politically, the outlet reported, but could create public pressure on the new Trump team to carry it forward ^[1].

Why it matters for patients

For adults with obesity who do not also have diabetes or heart disease, the practical effect of the current law is that Medicare does not cover Wegovy or Zepbound for weight loss. That leaves patients paying out of pocket unless they have another source of coverage. Whether the proposal would have changed cost-sharing for patients, and how it would have applied across state Medicaid programs, has not been reported.

Medicaid is jointly run by the federal government and the states, and eligibility and covered benefits differ by state, so a federal reinterpretation would not necessarily mean identical coverage everywhere. Details on how that would work were not spelled out in the announcement ^[1].

People already taking these drugs for diabetes or heart disease would not have been affected by the change, since Medicare already covers those uses ^[1].

The proposal also would not have applied to drugs like Ozempic or Mounjaro used for weight loss in people without diabetes, because those products are approved for different uses.

What happens next

Because the proposal was issued as a proposed rule rather than a final one, it would only take effect if the incoming administration completed the process ^[1]. Whether the Trump administration will move it forward, and on what timeline, has not been reported.

Until a rule is finalized, Medicare's coverage rules for Wegovy and Zepbound remain as they were: covered for diabetes and heart disease, not for obesity alone ^[1].

Advocates on both sides were expected to weigh in during any comment period, and spending was a central question, since covering obesity drugs for a large Medicare population could increase program costs ^[1].