Treating obesity as a disease: Will new Medicare, Medicaid programs expand access to GLP-1 drugs?

For patients with obesity and their physicians, the landscape of treatment options and insurance coverage is shifting rapidly, including at the federal level.

This year, the U.S. Centers for Medicare & Medicaid Services (CMS) announced two new programs that indicate a shift in how the federal health programs cover GLP-1 antiobesity drugs.

CMS’ new Medicare GLP-1 Bridge program will provide eligible Medicare Part D beneficiaries with access to certain GLP-1 antiobesity medications starting July 1 through December 2027. Meanwhile, the Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) Model started in May and will run through the end of 2027 for eligible Medicaid beneficiaries. The GLP-1 medication access is expected as of July 1.

The programs indicate the federal regulators are recognizing obesity as a complex chronic disease and changing the coverage for the drugs that have become one of the hottest issues across health care. Tracy Zvenyach, Ph.D., M.S., R.N., is vice president for advocacy and research at the Obesity Action Coalition (OAC), a national patient advocacy organization that has spent more than two decades advancing access to evidence-based obesity care.

Zvenyach spoke with Medical Economics about drug pricing, concerns around compounded GLP-1 medications, the role of metabolic and bariatric surgery in comprehensive obesity care, and the persistent weight bias and stigma that continue to shape — and too often distort — how patients are treated across the health care system.