In recent remarks at the Aspen Institute, Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz signaled that changes to CMS coverage of GLP-1 weight-loss medications could arrive “very soon.” He declined to take a firm position due to the “market-moving” implications but said “we’re in the middle of a lot of action in that space.”   

These remarks are striking given the recent history of efforts to expand Medicare coverage for GLP-1s. Currently, Medicare covers GLP-1 drugs when prescribed for their approved metabolic indications (e.g., for Type 2 diabetes), but not when the primary indication is weight loss or obesity without co-morbid diabetes. This is due to federal law: Medicare and Medicaid are not allowed to cover reimbursement for so-called lifestyle drugs, which among other things include drugs for weight loss or weight gain.   

A 2024 Biden Administration effort proposed to “reinterpret the statutory exclusion of agents when used for weight loss such that it would not apply to drugs when used to treat beneficiaries with obesity.” In other words, it would have allowed coverage of anti-obesity drugs – including GLP-1s – to beneficiaries with obesity, not just those with diabetes. The Trump Administration opted not to finalize those provisions of the rule, however, stating the policy was “not appropriate at this time.” Dr. Oz’s comments suggest that CMS leadership may be reconsidering that prior stance. 

Before CMS makes any policy moves, there are many important considerations, including budgetary implications, potential health outcomes, and pharmaceutical market pressures. 

The estimated multibillion dollar price tag looms large. The Congressional Budget Office estimates that authorizing Medicare coverage of anti-obesity medicines would raise net federal costs by about $35 billion from 2026–2034, even after factoring in some medical offsets. A 2025 JAMA Health Forum analysis finds Medicare spending on GLP-1s could reach $65.9 billion over 10 years with just 10-percent uptake – even assuming Inflation Reduction Act (IRA) price-negotiation discounts starting in 2027. Policymakers should gather strong evidence that the health benefits justify the costs. Provided that evidence is conclusive, of course it’s possible that the multibillion-dollar price tag may be a bargain. 

Evidence shows that GLP-1 therapies can deliver clinically meaningful outcomes in patients that take them as prescribed. One trial showed reductions in cardiovascular events in people with obesity and established cardiovascular disease, even without diabetes. Longer trials also show two-year weight-loss durability when taking the drugs, underscoring disease-modifying potential. But evidence of efficacy gets cloudier in practice. Two realities collide in routine care: persistence and what happens when patients stop. Real-world analyses consistently find substantial discontinuation within the first year for anti-obesity GLP-1s, driven by side effects, access hurdles, and supply variability; adherence is “moderate” at best in multi-payer data, with many patients never reaching or sustaining target doses. And if patients discontinue, weight tends to return. One study showed participants regained roughly two-thirds of lost weight within a year off a GLP-1, with parallel loss in cardiometabolic gains. Population- and program-level benefits hinge on sustained treatment plus supportive care – things that cost money and require system capacity. 

Further clinical considerations may multiply as access expands. Evidence of therapeutic value for GLP-1s keeps widening beyond weight and diabetes. At the same time, clinicians must navigate evolving safety guidance. Labels already flag diabetic retinopathy complications, requiring ophthalmic vigilance. Current multi-society anesthesiology guidance generally allows medical continuation before elective surgery with tailored risk mitigation, but teams still need explicit protocols. Regulators are also continuing pharmacovigilance work: the Food and Drug Administration’s (FDA) review has not found evidence that GLP-1s cause suicidal thoughts or actions (monitoring continues), and Europe recently added a very rare ocular event to semaglutide labeling. Both are reminders that scale can uncover infrequent harms that must be managed. 

The potentially eligible population is also enormous. The Centers for Disease Control and Prevention estimates that adult obesity is at approximately 40 percent nationally, with severe obesity now approaching 10 percent overall and roughly 7 percent among adults over 60 – precisely the Medicare-heavy age bands. That prevalence, layered onto high cardiometabolic comorbidity burdens, means any broad coverage decision will be felt not only at the margins but across tens of millions of lives and thousands of clinics and pharmacies. It also means utilization can scale far faster than the needed health-system infrastructure (nutrition, behavioral support, and longitudinal monitoring) to lock in durable outcomes. 

An important consideration is also the market. GLP-1 manufacturers only recently resolved drug shortages for semaglutide and tirzepatide. While manufacturers are racing to expand capacity, companies have acknowledged demand could outstrip supply even with large investments – an operational risk if public programs open the floodgates. We should be careful to avoid pushing people to non-FDA approved, compounded GLP-1 products because of ill-considered accelerated access that may lead to the resurgence of drug shortages. Part D design should also be considered. The benefit redesign from the IRA has increased the payment burden and liability on plans and manufacturers, cutting Medicare reinsurance from 80 percent to 20 percent for brands (which are the vast majority of GLP-1s). 

If CMS does follow through with an expanded Medicare GLP-1 program (even via pilot), the implications could be far-reaching. For patients and clinicians, it could open access to GLP-1s for a larger group of individuals dealing with obesity but lacking diabetes, increasing coverage, and incentivizing coordinated metabolic care. For payers and health systems, it would require new processes for utilization management, monitoring of adverse effects, and integration of behavioral and lifestyle supports. For drug manufacturers, expanded coverage would likely boost demand significantly, with GLP-1 products poised to gain new public-insurance markets. For policy and research, pilot data will be critical in shaping future decisions on full coverage, cost containment, risk mitigation, and long-term safety and efficacy.