Illustration: Maura Losch/Axios
Congress may be back on the hook for deciding whether Medicare should pay for GLP-1s and other anti-obesity drugs after the Trump administration kept a longstanding coverage prohibition in a 2026 Medicare payment rule.
- But the price tag doesn't bode well for an immediate revival of the Treat and Reduce Obesity Act.
Why it matters: Expanding coverage to the blockbuster drugs would be politically popular but would carry a cost of perhaps $35 billion through 2034. For that reason, it's highly unlikely Republicans would wrap the policy into the reconciliation package.
- Instead, backers of the idea may have to resolve their ambitions with HHS Secretary Robert F. Kennedy Jr.'s skepticism of the drugs, with the possibility of bringing up a scaled-down TROA later this session.
Catch up quick: The Biden administration in December proposed requiring Medicare and Medicaid to cover treatments like Wegovy and Ozempic, arguing that obesity is a chronic disease and that a policy shift could potentially lower the prevalence of obesity-related illnesses.
- But Friday, the Trump administration released a final rule that continued to limit coverage to diabetes and heart disease, while saying it could revisit the policy in the future.
- A PhRMA spokesperson told Axios that the trade group was "disappointed by CMS' decision" since there's a strong evidence base on how the medicines "can provide meaningful value to patients and generate savings for our health care system."
- The group will continue to work with the Trump administration and Congress on ways to improve affordability and access for those in Medicaid and Medicare who are living with obesity, the spokesperson said.
State of play: Versions of TROA have been introduced every Congress for the last decade. But in June, the House Ways and Means Committee for the first time approved a limited version in an overwhelmingly bipartisan vote of 36–4.
- That version would have covered the weight loss drugs only for people diagnosed as obese and who have been taking the drugs at least one year before enrolling in Medicare. Ways and Means staff said at the time that it would cost $1.7 billion over a decade.
- The Joint Economic Committee has estimated that people with severe obesity generate $9,591 a year in extra health care costs.
- One complicating factor is that several of TROA's longtime champions, including past cosponsors Sen. Tom Carper and Rep. Brad Wenstrup, have retired from Congress.
What we're watching: Rep. Raul Ruiz, the main Democratic cosponsor in the House, is talking about potentially teaming up with Rep. Mike Kelly as the new GOP cosponsor on the bill, Ruiz's office told Axios.
- The lawmakers are still interested in advancing the bill, but Ruiz's office said they're still figuring out the timeline.
- "The Treat and Reduce Obesity Act is bipartisan legislation that gives Americans the tools they need to live longer and healthier lives," Ruiz told Axios.
- "Sadly, the Trump administration is now walking back critical progress made under President Biden to expand access to life-saving anti-obesity medications. This makes it all the more important to pass TROA."
Wegovy and Ozempic are subject to the next round of Medicare drug price negotiations, which in theory could bring down coverage costs beginning in 2027. Negotiated prices won't be announced until later this year.
