Trump revokes planned Medicare/Medicaid coverage for GLP1s

Last year, the Biden administration's proposal to include GLP1s under Medicare part D was welcomed and lauded in the media:

Biden-Harris administration keen on GLP1s

The outgoing Biden-Harris admin puts out a proposal on widening access to GLP1s, which we hope the incoming Trump admin will also adopt.

GLP1 GuideGLP1.Guide Staff

This year, it looks like the Trump administration has scrapped that proposal and will no longer pursue coverage for GLP1s:

CMS won’t cover GLP-1 drugs for weight loss in Medicare, Medicaid

The Trump administration last week dropped a Biden-era proposal that would have expanded coverage of GLP-1 drugs in Medicare and Medicaid programs, saying that it was “not appropriate at this time.” Here’s what you need to know.

Advisory Board

As reported by HFMA, rather than outright rejecting the proposal, the Trump administration decided not to approve the proposal:

Final 2026 rule for MA, Part D leaves out proposed GLP-1 drug coverage

The Trump administration’s final rule setting policy and technical changes for Medicare Advantage (MA) in 2026 did not carry forward a proposal regarding GLP-1 drug coverage, but key provider-focused provisions were retained. The rule, which is scheduled for formal publication April 15 and also sets 2026 Medicare Part D policies, excludes a Biden administration proposal…

HFMANick Hut

Why? The primary issues seems to be cost.

It's likely that the Trump administration has decided to not pursue coverage for many reasons:

• The Department Of Governmental Efficiency ("DOGE") effort to cut government costs
• Increasing costs of GLP1s due to Trump administration Tariff schemes
• A philosophical disagreement with coverage of GLP1s

But regardless of the reasoning, this is another blow to GLP1 accessibility for most Americans – in addition to the removal of other avenues like compounding which are unlikely to return.

Is this a result of RFK Jr's stance on GLP1s?

This announcement serves as a look into the effects of the new administration on the GLP1 space – and while RFK Jr. has noted that he considers them "miracle drugs" – they are clearly worried about amount of use and cost:

Robert F. Kennedy Jr. worries anti-obesity drugs could ‘double insurance costs for employers’

Much of the Senate hearing on Thursday for the HHS nominee focused on his views of vaccines.

BenefitsProAllison Bell

Cost-related considerations also should factor into decisions on coverage, he indicated, saying that unrestrained access to the drugs conceivably would cost “over a trillion dollars per year. It would double the insurance costs for employers in the country, and it would be a tsunami.”

This was taken into account by the Biden administration:

The Biden administration acknowledged costs were a potential concern, estimating that 10-year expenditures would total $24.8 billion in Medicare and $11 billion in Medicaid, plus $3.8 billion in state Medicaid spending. The hope was that net savings would accrue from avoiding downstream obesity-related complications.

Most would agree that the savings from obesity-related complications and hospital visits would outweigh the initial costs, but this is up to the current administration to decide on.

One more important opinion is the seemingly reactionary response of RFK Jr to the propensity of American consumers to take drugs as solutions to medical issues, and a perceived antagonistic relationship with drug producers outside the US:

RFK Jr. weighs options for Medicare, Medicaid coverage of GLP-1 medications

As discussions unfold, Kennedy seeks to balance drug accessibility with concerns about the long-term costs of providing GLP-1 medications through federal programs.

Scripps NewsBy: Justin Boggs

“They’re counting on selling it to Americans because we’re so stupid and so addicted to drugs,” Kennedy told Fox News’ Greg Gutfeld in October 2024.

There has been vanishingly little direct comment on GLP1s (outside of supposed pharmaceutical tariffs), so it has been hard to discern where the current administration (and RFK Jr) stand on GLP1s going forward.