White Paper: CMS Has the Legal Authority to Cover Anti-Obesity Medications

Today, the Alliance for Aging Research, in partnership with Akin Gump Strauss Hauer & Feld LLP, released a white paper titled, “CMS Has the Legal Authority to Cover Anti-Obesity Medications (and Should): A Legal, Regulatory and Policy Assessment.” The white paper argues that the Centers for Medicare & Medicaid Services (CMS) has the legal authority to cover anti-obesity medications (AOMs) under Medicare Part D but has chosen not to do so, relying on an outdated interpretation of the Social Security Act (SSA). 

Obesity is a serious and chronic disease, and GLP-1 agonists (GLP-1s) like Ozempic, Wegovy, Zepbound, and Mounjaro are safe and effective treatments for the condition. Initially developed for diabetes, these drugs have since been shown to be effective in reducing body weight and improving health outcomes, including reducing cardiovascular risks and lowering the chance of developing comorbidities. The white paper notes that CMS’s 2005 policy suggested that AOMs could be covered for obesity, yet recent guidance has reversed this stance, leaving patients without access to these potentially life-saving treatments. The white paper also delves into the ongoing work that is being done across the advocacy community and Congress to get these medications covered.

CMS must make changes now to increase access to this care and protect beneficiaries. Read the full report.