Medications for weight loss may receive funding from Medicaid

• CMS is preparing a pilot program for coverage of weight loss medications
• The GLP-1 medication prices remain high for patients
• Some states are quickly covering medications for weight loss

The Centers for Medicare and Medicaid Services (CMS) are preparing a pilot program that could change the approach to weight loss medication coverage among low-income and elderly Americans. Along with new plans, Medicare and Medicaid may gain the ability to cover certain weight loss medications, which would be a significant departure from the current policy that primarily excludes medications that are exclusively used for weight control.

Medications that may be included in the program include Wegovy, Ozempic, Zepbound, and Mounjaro, which belong to the class of medications known as GLP-1 receptor agonists. Studies have shown that these medications can help patients reduce weight by 15-20%, but their high price, ranging from $5,000 to $7,000 per year, makes them inaccessible for many.

The pilot program is expected to begin for Medicaid participants in April 2026, and for Medicare participants—in January 2027. This step could expand access to weight loss medications for over 100 million adult Americans who meet the criteria for obesity.

Currently, despite the potential advantages, there remains a concern about the fact that most patients regain lost weight after stopping the medication, raising questions about the long-term effectiveness of such treatments.

In addition, some states are already quickly covering medications that are used for weight loss, through budget constraints. For example, California recently passed a budget that includes coverage for GLP-1 agonist medications for weight loss under Medicaid. This could lead to even greater restrictions on coverage in other states.

Tags: USA/Well-being