Medicare, Medicaid to try coverage of GLP-1s for obesity: Report
Why it matters: The Health and Human Services Department in April rejected a Biden administration proposal to allow Medicare and Medicaid to cover the injections for weight-loss.
That plan would have cost nearly $40 billion over 10 years.
The big picture: The Center for Medicare and Medicaid Innovation is drawing up plans for a five-year experiment in which Medicare prescription drug plans and state Medicaid programs could opt to cover Ozempic, Wegovy, Mounjaro and Zepbound for weight-loss, the Washington Post reported Friday.
Wegovy and Zepbound have been approved by the FDA for weight-loss, but many doctors prescribe Ozempic, Mounjaro and other GLP-1 drugs off-label for that purpose.
The experiment could start in April 2026 for Medicaid and January 2027 for Medicare plans, per WaPo.
"All drug coverages undergo a cost-benefit review. CMS does not comment on potential models or coverage," the agency said in a statement to Axios.
Medicare already covers GLP-1s to treat diabetes and heart disease. An October report from congressional scorekeepers found that about half of seniors with obesity are already eligible for GLP-1 coverage to treat other conditions.
Insurers have resisted plans for Medicare and Medicaid to expand coverage for the drugs, which can cost more than $1,000 per user per month.
HHS Secretary Robert F. Kennedy Jr. panned the use of Ozempic and other GLP-1 drugs for weight-loss before being nominated but has taken a softer stance since then, calling them "miracle drugs" for obesity and diabetes while saying they shouldn't be prescribed without exercise.
States already have the option of covering GLP-1s for obesity through Medicaid, though only 13 do.
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