Some insurers are sounding the alarm that Medicare coverage of weight loss drugs could increase premiums.
On Nov. 26, CMS issued its proposed rule for Medicare Advantage plans in 2026. The rule included a proposal to allow the program to pay for weight loss drugs for individuals with obesity.
The coverage would also extend to Medicaid beneficiaries. The White House estimated more than 7 million people would be eligible for weight loss drugs if coverage is expanded.
Ceci Connolly, president of the Alliance of Community Health Plans, called the proposal "irresponsible, without further analysis and stakeholder engagement."
"We are deeply concerned with the proposed coverage expansion of weight-loss drugs in Medicare and Medicaid," Ms. Connolly said. "The excessive prices drugmakers command for GLP-1s have enormous cost consequences for consumers, taxpayers and employers."
The organization represents 30 nonprofit health plans.
Ms. Connolly also pointed to the paucity of long-term research into the effectiveness of GLP-1 drugs for patients with obesity, especially those without other chronic conditions.
GLP-1 drugs approved for weight loss include Wegovy and Zepbound. Other GLP-1 drugs, including Ozempic, are approved to treat Type 2 diabetes. The drugs can cost more than $1,000 a month without insurance.
Research published by the Blue Cross Blue Shield Association in May found that 58% of patients discontinue the use of GLP-1s before seeing clinically meaningful health benefits.
Some lawmakers also expressed concern with the proposal. In a statement published Nov. 26, Sen. Bernie Sanders, chair of the Senate Committee on Health, Education, Labor and Pensions warned the proposal could cause "premiums to skyrocket."
"If this proposal is to be financially responsible for seniors and taxpayers, Medicare and Medicaid cannot pay up to 10 to 15 times more for these drugs than they cost in Europe and other major countries," Mr. Sanders said.
Medicare coverage of the drugs could cost the federal government $35 billion by 2034, according to estimates published by the Congressional Budget Office in October. The office also estimated the cost of the drugs will decline over time.