The Centers for Medicare & Medicaid Services (CMS) announced today a proposal to require Medicare Part D and Medicaid programs to cover medications used to treat obesity.
Weight loss drugs have only previously been covered under Part D if the drug is also used to treat another condition medically accepted, such as diabetes.
If finalized, the proposed rule would provide more Americans access to transformative medications and improve the health and quality of life for millions of people who have obesity, CMS said.
The rule also aims to remove barriers to care resulting from inappropriate use of prior authorization and internal coverage criteria and would also increase guardrails around the use of artificial intelligence to protect access to health services.
“The Biden-Harris Administration has worked to ensure that the Medicare Advantage and Part D prescription drug programs work for people with Medicare, adopted policies holding plans accountable for providing high-quality health care, and protected the sustainability of the Medicare program,” said CMS Administrator Chiquita Brooks-LaSure in a statement. “This proposed rule continues to build on this work by expanding access to anti-obesity medications for people with Medicare and Medicaid, further addressing prior authorization concerns in Medicare Advantage, and promoting informed choice and transparency by requiring Medicare Advantage plans to share provider directory information on Medicare Plan Finder.”
The CY 2026 MA and Part D proposed rule will have a 60-day public comment period, click here to review or comment no later than January 27, 2025. For more information about the proposed rule, click here for the CMS fact sheet.