A significant shift in U.S. healthcare policy is on the horizon as the Trump administration prepares a five-year experiment aimed at extending Medicare coverage and Medicaid expansion to include expensive weight loss drugs for obese Americans.
Under the proposed initiative, state Medicaid programs and Medicare Part D insurance plans will have the option to voluntarily cover popular GLP-1 medications such as Ozempic, Wegovy, Mounjaro, and Zepbound, specifically for “weight management” purposes. This move, detailed in Centers for Medicare and Medicaid Services documents, signals a potentially transformative approach to obesity treatment within government insurance.
This experiment marks a pivotal moment, especially given the administration’s prior stance. It contrasts sharply with an earlier decision in April that stated neither Medicare nor Medicaid would cover GLP-1s for weight loss, effectively scrapping a Biden administration proposal to do so.
The ambitious project is slated to commence in April 2026 for Medicaid and January 2027 for Medicare plans. It will be overseen by the Center for Medicare and Medicaid Innovation (CMMI), a specialized testing lab dedicated to exploring novel healthcare payment methods with the dual goals of cost reduction and care improvement.
The concept of increased healthcare policy coverage for anti-obesity medications has garnered varied reactions. Chiquita Brooks-LaSure, who led CMS during the Biden administration, lauded the experiment as a potential “game changer,” emphasizing the growing recognition of obesity as a serious health condition requiring comprehensive treatment. Conversely, some within the Trump administration, like Health and Human Services Secretary Robert F. Kennedy Jr., have voiced concerns over the drugs’ steep costs, advocating for diet and exercise as primary strategies.
Cost remains a central point of contention. Congress’s official scorekeeper estimates that providing Medicare coverage for obesity treatment could cost approximately $35 billion from 2026 to 2034. Influential figures in the “Make America Healthy Again” movement, such as Jillian Michaels and Mark Hyman, also express skepticism, citing concerns about metabolic changes and weight regain post-cessation, a challenge acknowledged by ongoing research.
David Rind of the Institute for Clinical and Economic Review, while acknowledging the substantial health benefits of GLP-1s and their reasonable pricing for individuals (around $5,000-$7,000 annually), highlights the immense financial burden posed by the sheer number of obese Americans—around 100 million—who would likely require lifelong treatment. This economic reality has led insurers to heavily pressure administrations against broad coverage, contributing to the uncertainty surrounding state and drug plan participation, particularly amidst concerns about federal Medicaid funding losses.
Beyond merely covering medications, the administration’s experiment aims to foster a “healthy lifestyle support system.” Participating Medicare plans and state Medicaid programs will be required to complement drug coverage with essential diet and exercise coaching, ensuring a holistic approach to patient metabolic health. All eligible enrollees in participating Part D plans will gain access to these weight loss drugs.
Despite widespread government staffing cuts, the administration has signaled a strategic strengthening of CMMI, the entity spearheading this GLP-1 medications funding experiment. The center was largely exempted from earlier staff reductions and is now actively recruiting approximately 100 new workers, underscoring the administration’s commitment to this innovative obesity treatment initiative and its potential implications for the future of healthcare policy in the United States.
