Medicare Opens Path to Covering Popular Weight Loss Drugs Under New Voluntary Program

Some Medicare enrollees may soon be able to access widely used weight loss drugs under a new voluntary model program announced by the Centers for Medicare and Medicaid Services.

Under the plan, eligible beneficiaries would pay $50 a month for certain GLP-1 medications used to treat obesity, a significant reduction from current market prices. Medicare is generally prohibited by law from covering drugs prescribed solely for weight loss, but federal officials say these medications play an important role in addressing chronic health conditions.

The program, called Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth, or BALANCE, follows a recent agreement between the Trump administration and drugmakers Eli Lilly and Novo Nordisk. The deal allows Medicare to offer discounted access to their weight loss medications through Medicare Part D plans, paired with lifestyle and nutrition support.

CMS Administrator Dr. Mehmet Oz said the initiative aims to expand access to medications that have previously been out of reach for many patients, while also controlling costs for taxpayers. CMS will negotiate pricing and eligibility criteria with drug manufacturers, and participation will be voluntary for states, insurers, and pharmaceutical companies.

Medicare beneficiaries are expected to begin accessing the medications through a short-term demonstration program as early as July. State Medicaid programs can opt in starting in May 2026, while Medicare Part D plans may participate beginning in January 2027. The demonstration program is scheduled to run through December 2031.

Eligibility would include people who are overweight with prediabetes or a history of cardiovascular disease, as well as those with obesity and related conditions such as diabetes or uncontrolled high blood pressure. Federal officials estimate about 10 percent of Medicare enrollees could qualify under the expanded access plan.

The Biden administration previously proposed reinterpreting federal law to allow Medicare coverage of anti-obesity drugs, a move later halted by the Trump administration. Officials say the new agreement is designed to be cost-neutral for Medicare, unlike the earlier proposal, which was estimated to cost billions over a decade.

Health policy groups have welcomed the potential health benefits but say they want more details on costs and long-term impacts, noting that some patients stop taking GLP-1 drugs due to side effects.

Federal health officials say more than 70 percent of U.S. adults are considered overweight or obese, increasing the risk of serious chronic disease.

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