CMS is proposing a five-year experiment that would allow state Medicaid programs and Medicare Part D plans to cover GLP-1s for weight management on a voluntary basis, according to an Aug. 1 report from The Washington Post.
Ozempic, Wegovy, Mounjaro and Zepbound would be included in the program, along with Eli Lilly’s oral GLP-1, Orforglipron, if it’s approved next year.
The program would begin in April 2026 for Medicaid and January 2027 for Part D plans and will be conducted by the Center for Medicare and Medicaid Innovation, according to the report. The proposal is not final and could still go through a public feedback process.
In April, CMS chose not to move forward with the Biden administration’s proposal to cover anti-obesity medications under Medicare and Medicaid. The decision came after pushback from payers and concern over a projected $35 billion increase in federal spending over 10 years to cover the medications. CMS did, however, leave the door open for future rulemaking around the topic.
In January, CMS selected Ozempic and Wegovy to be included in the second round of price negotiations aimed at reducing drug costs for Medicare beneficiaries in 2027.
The demand and high cost of GLP-1 medications, which can exceed $1,000 per month, have led insurers and self-funded employers to make significant changes to their GLP-1 coverage policies in recent years, including dropping coverage entirely. According to a Mercer survey of more than 2,000 employers in 2024, 44% with 500 or more employees offer GLP-1 coverage for obesity. Among employers with 20,000 or more employees, 64% offer coverage.
Thirteen state Medicaid programs currently cover GLP-1s for obesity.
