CMS decision to remove obesity drug coverage from 2026 final rule disappoints societies
Key takeaways:
- On April 4, CMS announced it would not include Medicare Part D coverage of obesity drugs in its rule changes for 2026.
- Medical societies plan to advocate for passage of the Treat and Reduce Obesity Act.
A decision by CMS to not move forward with a proposed rule allowing obesity medications to be covered under Medicare Part D has several medical societies advocating for change.
As Healio previously reported, CMS on Nov. 26 proposed a rule change to remove a clause in the Medicaid section of the Social Security Act that prohibited Medicare Part D coverage for medications used for anorexia, weight loss or weight gain.
“Increases in the prevalence of obesity in the U.S. and changes in the prevailing medical consensus towards recognizing obesity as a disease since the beginning of the Part D program in 2006 have compelled CMS to reevaluate Part D coverage of anti-obesity medications for Medicare Part D enrollees with obesity where the drug’s prescribed use is not for a medically accepted indication that is currently covered under Part D,” the proposed rule stated. “We are proposing to reinterpret the statutory exclusion of agents when used for weight loss to allow Part D coverage of anti-obesity medications when used to treat obesity by reducing excess body weight or maintaining weight reduction long-term for individuals with obesity who do not have another condition for which the prescribed use is an medically accepted indication that is covered under the current Part D policy.”
On April 4, CMS announced its final rule changes for Medicare in the 2026 contract year. In the announcement, CMS stated it would not move forward with several provisions in the rule originally proposed in November, one of which was the proposed clause allowing for Medicare Part D coverage of obesity medications.
CMS did not state why it chose to remove the provision from the final rule, but said in its release that it could address the proposal and other removed provisions in future rulemaking.
Disappointment with decision
After the announcement, several medical societies released statements voicing their disappointment. One of those was the Endocrine Society, which said in a statement the decision “leaves in place a major barrier that prevents millions of Americans from receiving appropriate and evidence-based obesity treatment and care.”
In an interview with Healio, Robert W. Lash, MD, chief medical officer for the Endocrine Society, said the society stands behind CMS rules or legislation that would offer Medicare Part D coverage of obesity medications to all beneficiaries with the disease.
“We have medication to treat this disease right now, and to deny that treatment to people because they happen to be over the age of 65 years doesn’t make a whole lot of medical sense,” Lash told Healio. “Our organization is supportive of legislation that would make it possible for people who are older than 65 years with obesity to get the medications that they need.”
The Obesity Society also released a statement saying it was disappointed in CMS’s decision. Marc-André Cornier, MD, FTOS, president of The Obesity Society and professor of medicine and director of the division of endocrinology, diabetes and metabolic diseases, department of medicine at Medical University of South Carolina, told Healio that the lack of Medicare coverage for obesity medications has clinical and ethical implications.
“While there are proven treatments including obesity medications, most Americans including those on Medicare are not able to access interventions other than metabolic surgery, which is highly effective, but also a more invasive approach,” Cornier told Healio. “We are left in a position where obesity treatment options that are known to be effective are not practical for many living with obesity because they are not able to afford to pay out-of-pocket costs for these medications. Knowing there are options to treat a disease and not being able to prescribe them is disheartening for providers as well.”
Cornier added that the lack of coverage could lead Medicare beneficiaries to purchase less expensive compounded or counterfeit medications or pursue other nonconventional therapies.
Treat and Reduce Obesity Act
Providing Medicare coverage of obesity medications has been a focus on Capitol Hill for several years. In 2021, the Treat and Reduce Obesity Act was introduced in both houses of Congress. The bill would have removed language from the Social Security Act to allow coverage of obesity medications for Medicare Part D beneficiaries. According to congress.gov, both bills were referred to committees shortly after being introduced, but no further actions were taken.
Another version of the Treat and Reduce Obesity Act was introduced again in both houses in 2023. In 2024, the House of Representatives version of the bill was amended to allow Medicare coverage of obesity medications only for beneficiaries who previously had coverage for an obesity drug before enrolling in Medicare and had used a medication for at least 1 year. Like the 2021 version of the bill, the Treat and Reduce Obesity Act of 2024 was not voted on by either legislative branch during the 2023-2024 congressional session.
In addition to the language regarding obesity drugs, all versions of the Treat and Reduce Obesity Act expand Medicare coverage of intensive behavioral therapy for obesity.
Both The Obesity Society and Endocrine Society stated they are in favor of passage of the Treat and Reduce Obesity Act. Lash noted, however, that the Endocrine Society supports passage of the originally proposed bill and not the amended bill that ties Medicare coverage of obesity drugs to prior coverage and use.
“We felt that it did not address the needs of a large segment of the population who wasn’t able to get [obesity medication] in the first place,” Lash said of the amended bill. “We thought, in this case, it treated a large group of Americans unfairly.”
A call to action
Beyond the Treat and Reduce Obesity Act, Cornier and Lash said health care professionals need to advocate for Medicare beneficiaries to ensure obesity coverage in the future. Cornier said practitioners need to ensure obesity diagnoses are included in the medical records of patients with obesity and that all health care stakeholders need to raise awareness about obesity.
“We will engage and advocate in additional regulatory advocacy opportunities in future Medicare rules,” Cornier said. “We are calling on the entire medical community to join efforts to advocate for comprehensive and accessible obesity care. Given the rates of obesity, it is likely that every person is somehow impacted by obesity. We need everyone from researchers to clinicians to communities to do their part to combat overweight and obesity if we want to make America healthy.”
Lash emphasized that obesity is not just a health issue, but a national security issue as well. He said about one-third of military-aged men are unable to serve in the U.S. military due to obesity and it is a concern many government officials do not discuss often enough.
“Get in touch with your legislators about the Treat and Reduce Obesity Act,” Lash said. “Remind them that obesity is a disease with real medical consequences and these medical consequences cost a lot of money. Covering obesity medications is a good thing overall. The more our legislators hear this, the more likely the bill is going to pass.”
References:
- Congress.gov. H.R. 1577. https://www.congress.gov/bill/117th-congress/house-bill/1577. Published March 3, 2021. Accessed April 9, 2025.
- Congress.gov. H. Rept. 118-959. https://www.congress.gov/congressional-report/118th-congress/house-report/959. Published Dec. 27, 2024. Accessed April 9, 2025.
- CMS decision on obesity medications leaves gap in health care access for millions of Americans. https://www.eurekalert.org/news-releases/1079671. Published April 7, 2025. Accessed April 8, 2025.
- Contract Year 2026 policy and technical changes to the Medicare Advantage program, Medicare prescription drug benefit program, Medicare cost plan program and programs of all-inclusive care for the elderly. https://www.cms.gov/newsroom/fact-sheets/contract-year-2026-policy-and-technical-changes-medicare-advantage-program-medicare-prescription. Published Nov. 26, 2024. Accessed April 8, 2025.
- Contract Year 2026 policy and technical changes to the Medicare Advantage program, Medicare prescription drug benefit program, Medicare cost plan program and programs of all-inclusive care for the elderly. https://www.cms.gov/newsroom/fact-sheets/contract-year-2026-policy-and-technical-changes-medicare-advantage-program-medicare-prescription-final. Published April 4, 2025. Accessed April 8, 2025.
- Endocrine Society disappointed in failure to extend Medicare and Medicaid coverage to anti-obesity medications. https://www.endocrine.org/news-and-advocacy/news-room/2025/endocrine-society-disappointed-in-failure-to-extend-coverage-to-anti-obesity-medications. Published April 7, 2025. Accessed April 8, 2025.
For more information:
Marc-André Cornier, MD, FTOS, can be reached at cornier@musc.edu.
Robert W. Lash, MD, can be reached at info@endocrine.org.
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