Medicare and Medicaid move toward covering Ozempic and other weight loss drugs
State Medicaid programs and Medicare Part D plans could soon voluntarily choose to cover these drugs for 'weight management,' The Washington Post reports, citing internal documents from the Centers for Medicare and Medicaid.
The proposed plan, which has not been finalized, would start in April 2026 for Medicaid and in January 2027 for Medicare.
Covering the drugs for weight loss would cost Medicare an estimated $35 billion from 2026 to 2034, the Post reports. However, Medicare is negotiating lower prices for Ozempic and Wegovy in 2027.
Currently, the popular drugs can cost upwards of $1,200.
These negotiations could save consumers money. Some experts have argued that Medicare prices can serve as a benchmark for private insurance companies and lead to savings, according to the health non-profit Kaiser Family Foundation. More insurers could also be pressured to provide coverage for these medications for weight loss if states opt into the proposed program.
Many GLP-1 medications, such as Ozempic, are intended to treat Type 2 diabetes, but in recent years, millions of Americans have turned to them for weight loss management.
Medicare covers GLP-1 drugs primarily for Type 2 diabetes treatment, while some private insurance companies already cover the drugs for weight loss. A 2024 Kaiser Foundation survey found that more than half of adults said the cost made it difficult to afford.
It's unclear how many states might opt in to the program. Thirteen state Medicaid programs have already chosen to cover GLP-1s for weight loss, the Post reports.
Novo Nordisk, the company that makes GLP-1s Ozempic and Wegovy, told the Post they believe 'comprehensive coverage through government and commercial insurance plans is critical to affordable health care and treatment options.'
This proposal comes after the Trump administration said in April that Medicaid and Medicare would not cover GLP-1 drugs for weight loss, the Post reports. This ended a previous plan under Joe Biden's administration to cover the drugs.
Members of the Trump administration may also be divided on the issue. Centers for Medicare and Medicaid Administration Mehmet Oz has previously called the drugs a 'big help,' while Health and Human Services Secretary Robert F. Kennedy Jr. has raised concerns about the cost of the drugs, the Post reports.
A Centers for Medicare and Medicaid spokesperson declined to comment on the proposal.
'All drug coverages undergo a cost-benefit review,' the spokesperson said in a statement. 'CMS does not comment on potential models or coverage.'
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