Trump Administration to Test Coverage Expansion for GLP-1 Medicines in Medicare and Medicaid Programs
The Trump administration has announced plans for a five-year pilot program, set to launch in April 2026 for Medicaid and January 2027 for Medicare, that allows state Medicaid programs and Medicare Part D plans to voluntarily cover GLP-1 weight-loss drugs for obesity management.
The program, which will be overseen by the Center for Medicare and Medicaid Innovation (CMMI), includes several GLP-1 receptor agonists currently approved for type 2 diabetes but used off-label or approved to aid weight loss, such as Novo Nordisk’s Ozempic and Wegovy, Eli Lilly’s Mounjaro and Zepbound, and a forthcoming drug Orforglipron (expected approval in 2026).
The pilot program aims to evaluate innovative payment models that could balance cost and health outcomes, as these drugs are costly, typically $5,000 to $7,000 per year. This raises concerns about long-term affordability, especially for Medicaid and Medicare populations.
The initiative marks a shift from earlier positions that excluded such coverage solely for weight loss purposes. This pilot reverses earlier administration decisions, including a rejection of the Biden-era proposal to cover GLP-1s for weight loss under Medicare and Medicaid. The new approach indicates increased federal openness to addressing obesity with pharmaceutical interventions in these programs.
If successful, the program could improve access to effective weight management drugs for millions of Medicare and Medicaid beneficiaries, potentially reducing obesity-related health complications and associated healthcare costs. However, voluntary participation and high drug prices pose challenges to widespread implementation.
The pilot program is still under development and not yet finalized. It may proceed without a formal public comment period, and it remains uncertain how many states and Medicare plans will opt into the experiment.
Critics argue that the nation cannot afford a lifelong drug regimen for the estimated 100 million obese Americans, while health influencers in Trump-aligned wellness circles have expressed concerns over metabolism disruption and weight regain once treatment stops.
The Congressional Budget Office estimates that the cost of Medicare covering GLP-1 drugs for obesity management could reach $35 billion from 2026 to 2034. David Rind, chief medical officer at the Institute for Clinical and Economic Review, states that while the drugs offer immense individual health benefits, their aggregate cost is a concern.
Chiquita Brooks-LaSure, CMS Administrator under Biden, praised the potential plan as potentially transformative. Currently, Medicare only covers GLP-1 medications for Type 2 diabetes, while some private insurers cover them for weight loss. Insurers have reportedly lobbied against broad coverage due to financial concerns.
The proposed program reflects a growing openness among federal policymakers to treat obesity as a chronic disease deserving pharmaceutical intervention. However, the question of cost and accessibility remains a significant concern.
- The new pilot program, planned to launch for Medicare in January 2027, could potentially expand the coverage of GLP-1 weight-loss drugs, such as Ozempic and Wegovy, for health-and-wellness purposes beyond just diabetes management, as part of obesity therapies-and-treatments.
- If the pilot program proves successful, it may pave the way for more affordable and accessible weight-management options for millions of Medicare beneficiaries, potentially improving overall health outcomes and reducing obesity-related healthcare costs; however, cost concerns and voluntary participation remain significant challenges ahead.
