CMS announces obesity drug coverage in Medicare, Medicaid

The Centers for Medicare and Medicaid Services on Tuesday announced a proposed rule for coverage of obesity drugs in Medicare and Medicaid starting in 2026.

After notice and comment rulemaking, the rule would need to be finalized under the Trump Administration. Comments must be submitted no later than January 27, 2025.

An estimated 3.4 million people would be newly able to obtain coverage for obesity drugs under Medicare Part D, CMS estimated. The cost to the federal government over 10 years would be $25 billion.

CMS expects no short-term premium impact, said Dr. Meena Seshamani, deputy administrator and director, CMS, during a call with reporters on Tuesday morning.

Medicare beneficiaries are being protected by a $2,000 out-of-pocket annual cap for prescription drugs that goes into effect January 1.

Current law excludes obesity drugs from being covered. Some states offer coverage for Medicaid but the majority do not.

The proposed rule revises the interpretation of the law and reclassifies obesity drugs as treatment for chronic disease.

The medical community agrees obesity is a chronic disease leading to heart disease, stroke and diabetes, CMS said. 

More than 40% of people in this country are considered obese and 22% of people with Medicare have a diagnosis of obesity, according to CMS.

CMS Administrator Chaquita Brooks-LaSure called the coverage “an historic step.”

As FDA Commissioner Robert M. Califf said, “”It’s the beginning of a revolution of the way weight is controlled,'” Seshamani said.

CMS did not specify the names of the obesity drugs coverage. 

The federal government would help states with the cost to Medicaid, according to Daniel Tsai, Deputy administrator and director of the Center for Medicaid and CHIP Services at CMS. The federal government would pick up $11 billion of the cost over the next 10 years, while states would be expected to cover $3.8 billion.

Questions on possible drug supply chain issues were referred to the Food and Drug Administration.