The Trump administration has decided against implementing a proposal for Medicare and Medicaid to cover weight loss drugs, the Centers for Medicare and Medicaid Services said in a filing published Friday by the agency.
A CMS spokesperson said the agency now believes that finalizing the proposal “is not appropriate at this time.”
“CMS may consider future policy options for AOMs pending further review of both the potential benefits of these drugs including updated clinical indications, and relevant costs including fiscal impacts on stakeholders such as state Medicaid agencies,” Catherine Howden, the spokesperson, said in an email.
Medicare already covers drugs that are also widely used for weight loss, like Ozempic and Mounjaro, when they are prescribed by doctors for other reasons like managing diabetes.
But under the statute governing Medicare and Medicaid, the federal government is generally banned from covering drugs “when used for weight loss.”
Under the Biden administration, CMS had proposed to reinterpret this statute, bypassing the Congressional ban on coverage of weight loss drugs for obese, but not overweight, patients.
Since obesity is now widely agreed to be a disease, the Biden administration had said, treatment of that disease should be covered by Medicare’s Part D prescription drug benefit.
They pointed to other situations when these kinds of drugs are allowed to be covered, like when weight change is caused by AIDS.
Expanding coverage of anti-obesity medications this way would also affect state Medicaid plans, officials said, since they are governed by the same law.
“CMS’ revised interpretation would recognize obesity to be a chronic disease based on changes in medical consensus,” the agency had said last year.
The proposal was expected to be costly for the federal government.
The Congressional Budget Office had previously estimated that expanding Medicare coverage to anti-obesity medications could add up to $35 billion over the next decade, even after factoring in expected savings from improved health of beneficiaries.
Medicaid programs would also have shouldered billions more in costs to cover the medications, Biden administration officials acknowledged, split between the federal government and states.
“States are also feeling substantial state budget pressure and we are doing our part to make sure patients, Medicaid enrollees all across the country can get access,” Dan Tsai, the agency’s top Medicaid official under the Biden administration, had told reporters.
Top advisers to Health and Human Services Secretary Robert F. Kennedy Jr., who now oversees CMS, among the nation’s federal health agencies, had criticized the Biden-era move.
Healthcare entrepreneur Calley Means, now a special government employee under Kennedy, had called it a “betrayal of any American who cares about” the Make America Healthy Again movement’s principles.
“Americans did NOT vote for mass injections in this election. They voted for a shift to ROOT CAUSE interventions and benefit flexibility,” Means said in a post on X at the time.
