Trump blocks plan for Medicare to cover weight-loss drugs

A proposal by the Biden administration to cover weight-loss medicines for obesity under Medicare has been axed by the White House, denying reimbursed access to millions of people across the US.

The Centres for Medicare and Medicaid Services (CMS) said late on Friday that it would not cover anti-obesity medicines (AOMs) like Novo Nordisk's Wegovy (semaglutide) and Eli Lilly's Zepbound (tirzepatide) under Medicare Part D, which covers health care expenses mainly for people age 65 and older, without giving a reason for the decision. Shares in both companies fell after the announcement.

CMS has historically prohibited coverage of these drugs under Medicare Part D, a relic of a decades-old federal statute that excluded "agents when used for anorexia, weight loss, or weight gain" from the programme.

However, that position was overturned by President Joe Biden last year in the face of growing evidence for the value of GLP-1-acting drugs like Wegovy and Zepbound beyond shedding weight. He proposed that they should be reimbursed for an estimated 3.4 million people in Medicare and 4 million in Medicaid who have obesity alone.

The rationale was that they could prevent people going on to develop obesity-associated conditions like diabetes and cardiovascular diseases like heart attack and stroke, which can end up costing health systems much more to treat.

Wegovy is already approved for cardiovascular risk reduction in overweight people with established heart disease, while Zepbound recently got a green light to treat a potentially life-threatening condition called obstructive sleep apnoea – indications that mean they can be prescribed under Medicare Part D.

Both semaglutide and tirzepatide have also shown efficacy in lowering the risk of kidney damage in overweight or obesity, meanwhile, and other studies have pointed to potential benefits in preventing heart failure, metabolic dysfunction-associated steatohepatitis (MASH), and Alzheimer's, amongst other diseases.

There has been an explosion in the use of obesity medicines, with many people opting to pay for them out-of-pocket in the absence of reimbursement coverage, and Novo Nordisk and Lilly have both responded by making them available for purchase direct-to-consumer (DTC) for a few hundred dollars per month.

For many people – and particularly older people who are on a fixed, limited income – that route is unaffordable, and Medicare Part D coverage may be the only way to get access.

Some analysts have suggested that President Donald Trump's decision to abandon the proposal is not unexpected and could become a lever for the administration in other negotiations with the pharma industry, including drug pricing.

Lilly said it was disappointed by the decision but would continue to work with the administration to "ensure people living with obesity are covered by Medicare and Medicaid and are no longer left behind," while Novo Nordisk called for the definition of obesity by CMS to be finalised and that the agency recognise it as "a serious chronic disease."

Photo by Brett Jordan on Unsplash