The Centers for Medicare and Medicaid Services announced a landmark policy change Friday, confirming that Medicare Part D plans will cover GLP-1 receptor agonists — including Wegovy, Zepbound, and Mounjaro — when prescribed for obesity treatment. The decision reverses a long-standing prohibition against covering weight loss medications and is expected to affect an estimated 3.5 million Medicare beneficiaries.
"This is the most significant expansion of Medicare coverage in a decade," said Dr. Robert Califf, FDA Commissioner. "Obesity is a chronic disease that contributes to heart disease, diabetes, and dozens of other conditions. Treating it is not cosmetic — it's essential healthcare."
The coverage will roll out in phases. Beginning January 2026, Medicare Part D plans may cover GLP-1 drugs for beneficiaries with a BMI of 30 or higher, or 27 or higher with at least one weight-related comorbidity such as hypertension or type 2 diabetes. Out-of-pocket costs will vary by plan, but CMS estimates the average copay will range from $45 to $110 per month, far below the $900-$1,300 list price.
The policy change comes amid growing evidence that GLP-1 drugs reduce cardiovascular events by 20% in overweight and obese patients, independent of weight loss. A recent study published in the New England Journal of Medicine found that semaglutide reduced all-cause mortality by 15% in a cohort of 17,000 patients over age 50.
Not everyone is celebrating. The Congressional Budget Office estimates the expansion will cost Medicare approximately $35 billion over the next decade. Some lawmakers have raised fiscal concerns, though bipartisan support from advocacy groups like AARP has muted opposition. "The long-term savings from preventing heart attacks and strokes will more than offset the upfront costs," said Dr. Ezekiel Emanuel, chair of the Department of Medical Ethics at the University of Pennsylvania.
