The debate over weight loss drugs just took a major turn — and it’s hitting Americans 65 and older right where it counts: their wallets.
The federal government has decided not to cover popular and powerful obesity medications like Zepbound and Wegovy under Medicare’s standard prescription drug benefit. The move comes under the leadership of President Donald Trump’s newly re-elected administration, and it reverses course from a proposed expansion drafted during the final months of President Joe Biden’s term.
For many older Americans struggling with obesity — and hoping to take advantage of game-changing new treatments — the decision could be deeply disappointing.
What Changed?
In November, shortly after Trump won reelection, the Biden administration proposed a rule that would have expanded Medicare and Medicaid coverage to include weight loss medications. These drugs, including Zepbound and Wegovy, have become household names thanks to their high-profile results and widespread popularity. But they also come with steep price tags, often costing hundreds of dollars per month.
The rule, which was expected to be finalized after Trump’s return to office in January, would have brought federal drug coverage closer in line with what many private employers and state Medicaid plans are already offering.
But late last week, the Centers for Medicare and Medicaid Services (CMS) — now under the leadership of Dr. Mehmet Oz, confirmed just one day earlier as the agency’s new head — said it would not proceed with that plan. The announcement effectively blocks coverage of weight loss drugs under Medicare’s Part D prescription program, which is the portion of Medicare that handles most outpatient prescriptions.
The agency did not offer a public explanation for the decision, and federal health spokespeople declined to comment.
Who’s Affected?
The ruling primarily affects people age 65 and older, who make up the vast majority of Medicare recipients. It also impacts disabled individuals who qualify for Medicare benefits.
Many of these people face serious health risks tied to obesity — including heart disease, stroke, and type 2 diabetes. And while Medicare already covers these drugs if prescribed for heart disease or diabetes, it will not do so solely for the treatment of obesity itself.
That’s a crucial distinction. Many patients — and their doctors — say these medications could be life-changing tools for long-term weight management and overall wellness. But without federal support, the out-of-pocket cost could be a dealbreaker.
What About Medicaid?
Medicaid programs are managed by both federal and state governments and typically cover Americans with lower incomes. More than a dozen states already do cover obesity medications under Medicaid, and Biden’s proposed rule would have extended that access more broadly.
However, cost remains a key issue. Government estimates pegged Biden’s proposal at $35 billion over the next decade, a number that gave pause to critics — including some in Trump’s health team.
Supporters of expanding access say it’s a long-term investment. By helping people lose weight and stay healthier, the drugs could reduce the incidence of costly conditions like high blood pressure, diabetes, and cardiovascular disease. Over time, that could save the system money.
But skeptics argue that offering these drugs to such a wide swath of the population — especially older Americans and low-income adults — could strain already-stretched budgets without guarantees of long-term adherence or success.
Enter Dr. Oz and Robert F. Kennedy Jr.
The leadership team making these decisions is grabbing just as many headlines as the policies themselves.
Trump tapped Dr. Mehmet Oz, a celebrity physician and former Senate candidate, to lead the Centers for Medicare and Medicaid Services — the federal agency responsible for administering both programs. His appointment was confirmed just one day before the new policy was announced.
Also playing a role is Robert F. Kennedy Jr., who now serves as Health and Human Services Secretary under Trump. Kennedy has been a vocal critic of weight loss drugs, including injectables like Wegovy, and is known for his skepticism of pharmaceutical companies in general.
Their combined influence signals a notable shift in how the Trump administration is approaching both health policy and high-cost drug coverage in this second term.
Public Opinion vs. Policy
Interestingly, a majority of Americans support the idea of government insurance programs helping pay for weight loss treatments. Surveys have found strong backing for both Medicare and Medicaid to offer coverage — particularly as these drugs become more mainstream and as obesity continues to be a leading cause of chronic illness in the U.S.
Private companies are already responding. According to a report from benefits consultant Mercer, about 44% of large employers — companies with 500 or more employees — covered obesity medications in 2023. That number is expected to grow as pressure mounts from workers, unions, and physicians.
But for now, older Americans relying on Medicare will have to pay out of pocket if they want access to the new class of injectable medications, unless they have another diagnosis, like cardiovascular disease, that qualifies them for coverage.
What’s Next?
With so much public interest and political attention focused on these drugs, the conversation is far from over. It’s possible that states, insurance companies, or even Congress could revisit the question of access and affordability in the months ahead.
For individuals, the decision leaves many with tough choices. For those who have seen the benefits of medications like Wegovy and Zepbound firsthand — or who hoped to start them — the lack of federal support may be a financial barrier too steep to overcome.
But the larger conversation — about how we treat obesity, how we fund preventative care, and who gets access to breakthrough medications — is only just beginning.
