Trump Administration mulls Medicare and Medicaid trials for GLP-1 medication coverage
The Trump administration is planning a five-year pilot program that would allow state Medicaid programs and Medicare Part D plans to cover GLP-1 drugs for weight management in obesity. This program, run through the Center for Medicare and Medicaid Innovation (CMMI), is scheduled to launch in April 2026 for Medicaid and January 2027 for Medicare.
This proposed expansion represents a policy shift from the earlier Trump administration decision in April 2025, which had rejected Medicare and Medicaid coverage of these drugs solely for weight loss. The pilot program is still under development and may proceed without a formal public comment process.
The pilot would include GLP-1 drugs like Ozempic, Wegovy, Mounjaro, Zepbound, and Eli Lilly's upcoming GLP-1 drug Orforglipron. The initiative is experimental, allowing coverage on a voluntary basis by participating plans, aiming to explore new payment models to improve care and contain costs for these increasingly used but costly weight-loss medications.
Annual costs for GLP-1 drugs range from $5,000 to $7,000, according to David Rind, chief medical officer at the Institute for Clinical and Economic Review. The road ahead for the proposed expansion is uncertain, with political and financial headwinds potentially impacting its implementation.
The program is managed by the Centers for Medicare and Medicaid Services (CMS) and the CMS Innovation Center (CMMI). If finalized, the program would provide access to weight-loss drugs for millions of obese Americans on Medicare and Medicaid, marking a significant policy change and a shift in public insurance policy as costs, benefits, and long-term outcomes are evaluated.
The Congressional Budget Office estimates the cost of Medicare covering GLP-1 drugs for obesity management could reach $35 billion from 2026 to 2034. However, the test program could be a first step towards a broader shift in how the U.S. health system addresses obesity.
Notably, the program is a reversal from a previous policy, as the Biden administration officially rejected a similar proposal in the past. Health influencers in Trump-aligned wellness circles, such as Jillian Michaels and Mark Hyman, have criticized the drugs due to concerns about metabolism disruption and weight regain. Insurers have reportedly lobbied against broad coverage due to financial concerns.
Chiquita Brooks-LaSure, CMS Administrator under Biden, praised the plan as potentially transformative, while HHS Secretary Robert F. Kennedy Jr. has expressed concerns about their cost and potential replacement of healthy lifestyle changes. CMS Administrator Mehmet Oz has publicly praised GLP-1 drugs, highlighting their potential benefits.
As the pilot program moves forward, it will be interesting to see how it reshapes the U.S. health system's approach to obesity, viewing it as a condition requiring ongoing medical treatment rather than just a lifestyle issue. The program's success or failure could have significant implications for the future of obesity treatment and management in the United States.
[1] Source: Kaiser Health News [2] Source: Politico [3] Source: The New York Times [4] Source: Eli Lilly and Company
The pilot program, managed by the Centers for Medicare and Medicaid Services (CMS) and the CMS Innovation Center (CMMI), aims to explore new payment models for GLP-1 drugs like Ozempic, Wegovy, Mounjaro, Zepbound, and Eli Lilly's upcoming GLP-1 drug Orforglipron, in the realm of science and health-and-wellness, particularly focusing on nutrition and weight-management, for individuals on Medicare and Medicaid. This experimental initiative, scheduled to launch in April 2026 for Medicaid and January 2027 for Medicare, could potentially mark a significant policy change in Medicare coverage, amidst financial and political headwinds.
