Why hasn't Medicare traditionally covered obesity drugs?
A statutory exclusion barred anti-obesity medications for weight loss — the CBO estimated adding coverage would cost ~$35 billion from 2026–2034 — and the Trump administration declined to finalise a Biden-era rule before the November 2025 deals created a $245/month obesity coverage route.
Medicare has not covered anti-obesity medications prescribed for weight loss, although it covers GLP-1s for other approved uses: it already covered Ozempic and Wegovy for diabetes and cardiovascular risk, and Zepbound for sleep apnoea. In November 2024 the Biden administration proposed extending Medicare and Medicaid coverage to obesity drugs, and the Congressional Budget Office estimated coverage would cost about $35 billion from 2026 to 2034, based on average annual costs of $5,600 per patient falling to $4,300. In April 2025 the Trump administration said it would not finalise that rule. About 12.5 million Medicare enrollees would qualify for anti-obesity medications in 2026, according to the CBO. The November 2025 deals then created a route to Medicare coverage for obesity at a $245 negotiated price and $50 copay. How this coverage is implemented and funded will shape the market's next phase.