New Medicare proposals will not cover obesity drugs

The US Centers for Medicare & Medicaid Services (CMS) issued a final rule on April 4, that modernizes and improves Medicare Advantage (MA), Medicare Prescription Drug Benefit (Part D), Medicare cost plan, and Programs of All-Inclusive Care for the Elderly (PACE) programs.

This it is not moving forward with a former Biden administration’s proposal that would have expanded coverage of costly anti-obesity drugs to more than 7 million Americans on Medicare or Medicaid. Notable among these are blockbuster brands Mounjaro (tirzepatide) from the USA’s Eli Lilly NYSE: LLY) and Wegovy/Ozempic (semaglutide) from Denmark’s Novo Nordisk (NOV: N).

Although Medicare by law is not allowed to cover drugs for weight loss, the Biden administration proposed reinterpreting the statute to allow coverage for the treatment of obesity as a chronic disease. Some 22% of Medicare enrollees were diagnosed with obesity in 2022, more than double the rate a decade prior.