Trump administration drops plan to extend Medicare coverage to Wegovy and Zepbound
Obesity drugs such as Wegovy and Zepbound remain uncovered by Medicare for weight loss, leaving list prices near $1,000 before insurance.
The Trump administration has decided against finalizing a Biden-era rule that would have allowed Medicare and Medicaid to pay for obesity drugs, among them Novo Nordisk's Wegovy and Eli Lilly's Zepbound [1][2]. The Centers for Medicare and Medicaid Services said the change was "not appropriate at this time" [2], while noting in a fact sheet that it may revisit coverage later [1].
The proposal, first put forward in November, would have limited coverage to people with a body mass index of 30 or higher [1]. When CMS introduced the rule, it said more than 7 million people would have gained access to the medicines [2]. The rule was never completed before President Donald Trump took office [1].
Price was central to the decision. CMS estimated the policy would cost Medicare $25 billion and Medicaid $15 billion across 10 years [2]. A separate congressional analysis found Medicare coverage of obesity drugs could reach $35 billion over nine years [1]. Wegovy and Zepbound each run about $1,000 before insurance and other rebates, and many health plans, Medicare included, currently do not cover weight-loss treatments [1].
Health and Human Services Secretary Robert F. Kennedy Jr. has been a vocal critic of GLP-1 medicines, contending that diet and exercise can address obesity [2]. In an October interview on Fox News, he said manufacturers count on selling the drugs to Americans because "we're so stupid and so addicted to drugs" [2]. Dr. Mehmet Oz, confirmed by the Senate on April 3 to lead CMS, has taken a friendlier tone; in a 2023 Instagram post he wrote that semaglutide medications "can be a big help" for people wanting to lose a few pounds [2].
Novo Nordisk and Eli Lilly did not immediately respond to requests for comment [1]. Shares of Lilly fell more than 2% in extended trading, and Novo Nordisk's stock declined more than 1% [1].
Why it matters for patients
Adults on Medicare who use these medicines only for weight loss are the group most affected. Coverage under the Biden plan was tied to obesity, defined as a body mass index of 30 or higher [1]. People who take the drugs for diabetes, or who face elevated risk of stroke or heart disease, already have coverage through Medicare or Medicaid, and that does not change [1][2].
Without insurance, the roughly $1,000 pre-rebate price is the practical obstacle; some patients simply cannot afford the drugs [1]. The medicines do not cure obesity, and most patients must stay on them to keep weight off [2]. It has not been reported when CMS might take up the question again, or what a future review would include [2].
What happens next
CMS said it may consider anti-obesity medications after further review of their costs and benefits, without offering a timeline [2]. Oz now heads the agency weighing that decision [2]. Neither company had commented as of April 4 [1].
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Sources
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