CMS Says “Not Yet” On Medicare Coverage for Obesity

We should be used to this by now. For years, we’ve urged policymakers to find a way out of the box that has Medicare denying coverage for obesity. This time, it seemed we were close. But close doesn’t count. Late yesterday, the Trump administration said “CMS is not finalizing” provisions of a proposed rule that would open up coverage for drugs like semaglutide and tirzepatide for obesity treatment.

It may be wishful thinking, but we find hope in the agency’s statement that:

“CMS may address these proposals in future rulemaking, as appropriate.”

Deep Disappointment

The Obesity Care Advocacy network has been hard at work in pursuit of this goal since its founding a decade ago. In response to this news, the group issued a statement, saying:

“OCAN is deeply disappointed in the decision not to extend coverage of obesity medications to Medicare recipients by the Centers for Medicare and Medicaid Services. This was a game-changing opportunity to propel millions of Americans fighting this chronic disease to better health.

“This will cost our healthcare system millions more in treating expensive diseases associated with obesity, not to mention lost productivity and economic output.”

Timing

Of course, cost is a factor in any decision to cover these drugs and those costs are already coming down. Medicare price negotiations will likely bring them down more. Thus, a senior fellow at the American Enterprise Institute suggested to Stat that the administration wants to wait for lower prices to kick in before expanding coverage.

A Popular Proposal

One thing about all of this is clear to us. This is an enormously popular proposal. Maybe the administration wants to reformulate the proposal and claim a win that is entirely their own – not a carry-over from the Biden administration. Or maybe they have other issues more pressing at the moment.

Regardless, we have little doubt the time is right for better access to obesity care. It will come.

Click here, here, and here for further perspective.

Saint Séverin No. 3, painting by Robert Delaunay / WikiArt

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April 5, 2025