The Center for Medicare and Medicaid Innovation may introduce a five-year pilot model to expand access to weight loss drugs, while the Trump administration appears to be backing away from a campaign trail promise to mandate coverage of in vitro fertilization (IVF), reports The Washington Post.
State Medicaid programs and Medicare Part D plans could choose to cover GLP-1 drugs like Ozempic, Mounjaro, Wegovy and Zepbound through the pilot model, documents obtained by the Post show. The model would start in April in Medicaid and in January 2027 for Part D plans.
GLP-1 users and advocates say the drugs’ ability to improve health outcomes is unparalleled. However, due to the drugs’ popularity, there has been concern over the impact on state and federal budgets from high levels of utilization.
The Centers for Medicare & Medicaid Services (CMS) proposed a rule requiring Part D and Medicaid to cover anti-obesity medications in November. But the final rule, released under the new administration, omitted this policy.
GLP-1 drugs Ozempic, Wegovy and Rybelsus were included, however, in the second annual list of drug price negotiations under the Inflation Reduction Act. An official under the Biden administration told the press all dosage forms and strengths of the drug would be included in negotiations.
Trump issued an executive order in an attempt to modify the program and issued new draft guidance to potentially include Part B drugs for the third cycle of negotiations.
But the administration may not require health insurers to cover IVF services, potentially severing a campaign promise by Trump, two people with knowledge of internal discussions told the Post. Proposals to expand coverage to people on the Affordable Care Act (ACA) exchanges have reportedly been halted.
It’s expected broader coverage would increase premiums. Lawmakers are also discussing whether to extend the ACA enhanced premium subsidies, which expire at the end of the year.
Trump previously dubbed himself the “fertilization president,” even as a new-look Department of Health and Human Services shuttered an office of reproductive technology surveillance within the Centers for Disease Control and Prevention.
The report suggests a path to coverage includes Congress passing legislation allowing IVF to be classified as an essential health benefit, but the White House has not yet demanded lawmakers address this priority. A White House spokesperson said the administration is still focused on the issue.
Trump signed an executive order in February aimed at expanding access to IVF, directing the Domestic Policy Council to explore ways to reduce the cost of treatment.