Medicare and Medicaid may soon cover GLP-1s for weight loss

Details of the proposed insurance pilot program

As discussed in a recent blog post, the U.S. administration is considering a five-year pilot program that would allow select Medicare Part D and state Medicaid plans to cover GLP-1 medications not only for diabetes—but also for weight-management indications. Presently, Medicare restricts GLP-1 coverage to type 2 diabetes treatment, leaving those seeking support for weight loss reliant on out-of-pocket costs or limited private insurance coverage. The Centers for Medicare & Medicaid Services have recently released a proposed rule that could enable coverage for anti-obesity medications under Medicare Part D, according to ASPE.

If approved, this pilot initiative is expected to begin in April 2026 for Medicaid and January 2027 for Medicare. The proposed rollout will be managed by the Center for Medicare and Medicaid Innovation (CMMI), which is responsible for testing innovations in healthcare delivery and cost control nationwide.

Crucially, the program's design incorporates holistic obesity care: prescription medications are paired with structured nutritional counseling and physical activity support. This comprehensive model aligns with up-to-date, evidence-based weight-loss interventions, giving patients resources for sustainable health improvement rather than a quick fix.

Why GLP-1 insurance coverage matters

GLP-1 receptor agonists are transforming weight management by mimicking natural hormones that influence satiety and appetite. In fact, a comprehensive meta-analysis of 47 randomized controlled trials showed these medications provided a mean weight reduction of 4.57 kg, a BMI reduction of 2.07 kg/m², and a waist size decrease of 4.55 cm compared with placebo. These medications have demonstrated meaningful, consistent results—helping many shed pounds while supporting metabolic health. As demand has soared, so has recognition from health policy leaders about how improved access could help reduce obesity-related health costs. An economic evaluation estimates that expanding Medicare coverage for GLP-1 receptor agonists would increase access and reduce obesity-related comorbidities while also imposing substantial national costs over a decade.

It’s important to recognize that medications like semaglutide and tirzepatide are not substitutes for a nutritious diet and steady exercise. The CMMI plans to emphasize lifestyle changes as a foundation—so these medications are viewed as one piece of a broader wellness strategy. According to recent GLP-1 research, combination approaches yield the best long-term results.

What this means for patients

Currently, more than 70 million Americans are insured by Medicaid—a joint state and federal program serving low-income individuals—and over 65 million are enrolled in Medicare, which supports adults aged 65+ and people living with qualifying disabilities. As of August 2024, only 13 state Medicaid plans have opted to cover GLP-1s for obesity treatment, typically with specific requirements such as minimum BMI thresholds, according to KFF. Medicare, by federal law, has not yet allowed weight loss as a covered indication.

If this pilot moves forward, it could reshape obesity care across the United States. Early expansion of GLP-1 coverage would relieve financial barriers for those who have struggled to get insurance for weight-loss medications such as semaglutide (Wegovy®) and tirzepatide (Zepbound®). Results from the pilot will also inform future policy, potentially opening long-term, nationwide coverage if the program leads to better health outcomes and lower total costs. Still, expert groups such as the Endocrine Society have emphasized that gaps remain, and they are advocating for prompt federal action to expand effective coverage.

Expanding access: affordability, HSA/FSA, and telehealth solutions

Out-of-pocket weight loss medication costs can exceed $1,300 per month for patients without insurance. Fortunately, even before the federal pilot, there are several avenues to improve affordability and access:

• HSA/FSA Payments: Certain weight loss programs and prescription medications can be paid for with pre-tax Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA), provided eligibility requirements are met. These options help patients reduce net costs, especially when paired with a doctor's letter of medical necessity and proper documentation.
• Savings Programs: Drug manufacturers often supply savings cards or patient assistance plans for those prescribed FDA-approved medications. Exploring pharmacy discounts and manufacturer programs can greatly reduce what you pay out of pocket—especially relevant for uninsured or underinsured people.
• Compounded Medication Options: In the event of brand drug shortages or high costs, some patients may be eligible for compounded versions of GLP-1 medications if prescribed by a licensed healthcare professional. However, always ensure you are working with reputable telehealth platforms and pharmacies.
• Telehealth-First Programs: Platforms like Shed connect patients with board-certified clinicians, eligibility screenings, and personalized GLP-1 prescriptions—all from home. Virtual programs streamline insurance and HSA/FSA paperwork, provide regular check-ins, and deliver medications directly to your door. GLP-1 lozenges and other forms may be available depending on clinical needs.

Looking ahead

The CMMI pilot is a landmark step, signaling a move toward more inclusive, holistic weight-loss care for diverse populations. While not a cure-all, it marks significant progress for patients seeking affordable options and long-term results.

For the latest updates on GLP-1 therapies, insurance coverage, and holistic weight loss, keep following the Shed blog and visit tryshed.com to explore telehealth-driven solutions or begin your personalized journey today.

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