Medicare, Medicaid Coverage Of Obesity Drugs Would Add $40bn In Government Spending

The proposal states that Part D plans could define "obesity" for coverage determination, but CMS said overly restrictive criteria would be inconsistent with formulary review requirements and step-therapy would not be allowed.

CMS may have underestimated the cost of covering obesity medications. (Shutterstock)
Key Takeaways
  • A CMS proposed rule requiring Medicare and Medicaid to cover obesity drugs would cost the federal government $25bn over 10 years in Medicare and federal and state governments $15bn in Medicaid, according to the agency.
  • The policy involves a ‘reinterpretation’ of the law informed by recent advances in obesity treatments.
  • The incoming Trump Administration will decide whether to finalize the rule.

Medicare Part D and Medicaid coverage of anti-obesity medications would increase federal and state spending by $40bn over 10 years, the Centers for Medicare and Medicaid Services estimated in a...

The policy long sought by manufacturers and patient groups is part of the 2026 Policy and Technical Changes to the Medicare Advantage and Medicare Part D Programs proposed rule.

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