GLP‑1 receptor agonists are widely recognized for aiding weight loss and controlling blood sugar, but access remains limited — especially for Medicare and Medicaid patients. That might change with a new CMS pilot program, The Washington Post reported Aug. 1.
As of April 2025, Medicare Part D and most state Medicaid programs do not cover GLP‑1s prescribed solely for weight loss, even for drugs approved by the FDA to treat obesity. Coverage typically is limited to conditions such as Type 2 diabetes, cardiovascular disease, chronic kidney disease or obstructive sleep apnea, according to the American Gastroenterological Association.
Thirteen states offer some Medicaid obesity coverage, with most of those states placing restrictions on coverage, as of August 2024, according to KFF.
Caroline Apovian, MD, co‑director of the Center for Weight Management and Wellness at Boston‑based Brigham and Women’s Hospital, told Becker’s she hopes this will change.
“I hope insurance coverage starts to improve and that Medicare and Medicaid do cover the cost of these drugs,” Dr. Apovian said. “It will be tough on [insurers] because these are expensive drugs, and it may take time to see return on investment.”
CMS’ pilot program set to launch in April 2026 for Medicaid and January 2027 for Medicare Part D would allow states to cover Ozempic, Wegovy, Mounjaro and Zepbound for obesity treatment, potentially expanding access to millions.
The pilot could cost $35 billion from 2026 to 2034, according to a Congressional Budget Office report published in October 2024. Pennsylvania projects its Medicaid spending on GLP‑1s could hit $1.3 billion in 2025, Spotlight PA reported.
Dr. Apovian said the benefits outweigh the costs.
“Very, very few people with obesity are not at risk,” she said, noting CDC data shows nearly 42% of U.S. adults are obese, often suffering from related conditions such as diabetes, heart disease and certain cancers.
