Medicare, Medicaid to Test Coverage of Weight-Loss Drugs Under New Pilot Program

Medicare Medicaid Weight-Loss Drugs: The US government is planning something big that might help millions of people who struggle with obesity. A new pilot program is being developed that could allow Medicare and Medicaid to start covering popular weight loss drugs. These drugs, like Wegovy, Ozempic, Mounjaro, and Zepbound, have helped many people lose a lot of weight, but they are very expensive. Most people who need them can’t afford to pay $5,000 to $7,000 per year. That might change soon.

The Centers for Medicare & Medicaid Services (CMS) is working on this plan through a special department called the Center for Medicare and Medicaid Innovation (CMMI). This team tests new ideas to try and improve healthcare and cut down costs. Internal documents show that this new plan would last five years. The idea is to start with Medicaid in April 2026, and then begin for Medicare in January 2027.

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If this goes through, it would be a big deal. The government doesn’t really cover weight loss drugs unless the person has a serious health issue, like heart disease. But this new plan would let people get help just for obesity itself. Ryan MacDonald, an analyst, said, “It does feel like a big shift in view, at least on the Medicare side,” since the past focus was always on saving money and not expanding coverage.

Millions Might Benefit

The number of people who could benefit is huge. Medicaid covers over 70 million low-income Americans. Medicare covers around 65 million people who are either over 65 years old or living with disabilities. Obesity is a major health issue in the U.S. According to the CDC, over 100 million adults in the country are obese. That means they have a Body Mass Index (BMI) higher than 30. More than 22 million of those are severely obese with a BMI over 40.

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The Biden Administration already showed support for making weight loss drugs more accessible. But this pilot actually started under the Trump Administration. It shows how serious the government is about helping people with obesity. There is also a big cost to consider. The Congressional Budget Office said that if Medicare starts paying for these drugs, it could cost $35 billion between 2026 and 2034.