The Trump administration is reportedly planning a significant five-year pilot program aimed at providing access to cutting-edge weight loss medications, including popular drugs like Ozempic, Wegovy, Mounjaro, and Zepbound, for eligible individuals enrolled in Medicare and Medicaid. This initiative marks a potentially transformative shift in public health policy, addressing the widespread challenge of obesity across the United States.
The ambitious plan is under development by the Centers for Medicare and Medicaid Services (CMS) and is slated for execution through the Center for Medicare and Medicaid Innovation (CMMI) testing lab. This platform is specifically designed to explore novel healthcare payment models with the dual objectives of reducing overall costs and enhancing health outcomes for millions of Americans.
Under the proposed program, state Medicaid programs and Medicare Part D insurance plans would be granted the autonomy to decide whether to cover these specific medications for the explicit purpose of ‘weight management.’ This represents a notable departure from the administration’s previous stance in April, which had indicated that Medicare and Medicaid would not cover these drugs solely for weight loss, and also differs from a prior Biden administration proposal that had been discarded.
While the proposal remains in its developmental stages, it may undergo a formal process that invites public opinion before its final implementation. If approved, the experimental program is projected to launch in April 2026 for Medicaid beneficiaries, followed by Medicare plans commencing in January 2027, according to reports.
The urgency behind such a program is underscored by alarming statistics: over 100 million adults in the U.S. are classified as obese, with a body mass index (BMI) of 30 or higher, and more than 22 million are severely obese. Given that Medicare currently provides healthcare coverage to 66 million Americans, the financial implications are substantial, with the Congressional Budget Office estimating potential costs for Medicare at approximately $35 billion between 2026 and 2034.
The medications at the center of this discussion belong to a new class known as GLP-1 receptor agonists. These drugs mimic natural hormones in the gut and brain that play a crucial role in regulating appetite and feelings of satiety. While initially developed to treat diabetes, drugs like semaglutide (Ozempic, Wegovy) and tirzepatide (Zepbound, Mounjaro) gained widespread prominence after receiving FDA approval for weight loss in 2021, becoming prevalent in public discourse and popular culture.
Medical professionals and researchers largely endorse these injectable medications as effective tools for combating obesity. Organizations such as the American Medical Association have urged health insurance companies to broaden their coverage, and the American Academy of Pediatrics supports considering these medications for children aged 12 and older struggling with obesity. However, without insurance, out-of-pocket expenses for these drugs can reach hundreds of dollars per prescription, and current insurance coverage is often limited.
Concerns persist regarding the long-term implications, particularly the observation that most individuals tend to regain lost weight upon discontinuing these drugs, raising questions about the lifelong financial commitment. While some officials, like Mehmet Oz, have lauded GLP-1s as a ‘big help’ for weight loss, others, such as Health Secretary Robert F. Kennedy, have voiced criticisms, advocating for diet and exercise as primary weight loss methods.
