Centennial, Colorado--(Newsfile Corp. - December 24, 2025) - The Obesity Medicine Association (OMA) released its Position Statement on Medicare and Medicaid Coverage and Expanded Access to Obesity Medications, detailing the association's recommendations and support for emerging federal policies expected to dramatically improve treatment access for millions of Americans living with obesity. The OMA commends the Centers for Medicare and Medicaid Services (CMS) and pharmaceutical partners, including Eli Lilly and Novo Nordisk, for collaborating on initiatives that reinforce the recognition of obesity as a chronic disease requiring comprehensive medical treatment.

The OMA's position focuses on several critical areas of expansion and improvement, urging policymakers to ensure equitable, affordable, and seamless access to care. While much is likely to change in the coming months to years, the following represents an initial preliminary OMA Position Statement, with a planned follow-up at a later date when policies are more definitive.

Medicare Coverage Pilots & Affordability (Starting 2026) The OMA supports the initial pilot of GLP-1 obesity medication coverage through Medicare Part D beginning in 2026, with eligibility based on BMI and obesity complications.

• Affordable Copay: Eligible Medicare beneficiaries who qualify under the demonstration project may pay a flat $50 monthly copay for injectable GLP-1 therapies, regardless of dose.
• Expansion Urged: The OMA urges a transition to a mandatory, permanent program in 2027 to ensure long-term, broad access.

Streamlined Prior Authorization (Preauthorization) The OMA urges CMS to approve obesity medications based on clinical criteria and without any preauthorization to reduce administrative burdens.

• If Required, Make It Seamless: If preauthorization remains necessary, the OMA calls for a frictionless, uniform process that applies equally to physicians, Nurse Practitioners (NPs), and Physician Associates/Assistants (PAs).
• Continuity of Care: Policy must ensure seamless access for patients currently prescribed obesity medications who age into Medicare eligibility.

Expanded Access for Medicaid and Cash-Pay Patients

These federal initiatives are expected to impact affordability beyond Medicare:

• Medicaid: The OMA urges all state Medicaid programs to adopt the GENEROUS (GENErating cost Reductions for U.S. Medicaid) model, which applies Most-Favored-Nation (MFN) pricing to lower costs and is slated to begin in 2026.
• Direct-to-Patient (DTP) Access: For cash-pay patients, oral GLP-1s are speculated to cost $150/month, and injectables $250-$350/month via DTP portals like TrumpRx, which connects users directly to manufacturer programs offering discounted cash prices.

Comprehensive & Forward-Looking Care

The OMA advocates for a holistic approach that includes medication and behavioral support.

• Oral Medications: OMA supports the inclusion of oral GLP-1 medications (such as orforglipron and oral semaglutide, with potential FDA review by 2026) in coverage, recognizing their role in long-term adherence and maintenance, especially for patients who cannot tolerate injections.
• Support for TROA: Medicare coverage of obesity medications serves as a bridge to expanded access but doesn't make it permanent. The OMA continues to support the passage of the Treat and Reduce Obesity Act (TROA) to permanently repeal the statutory exclusion on obesity drugs and enhance access to medications and Intensive Behavioral Therapy (IBT).
• Digital Health Tools: CMS should expand support for FDA-approved digital health tools, Medical Nutrition Therapy (MNT), and IBT to complement pharmacotherapy with accessible, technology-driven behavioral support.

A Springboard for Permanent Change

The OMA believes that establishing Medicare coverage of obesity medications signals federal recognition of obesity as a treatable chronic disease, creating momentum for the permanent removal of the statutory exclusion on obesity drugs. The lower prices achieved through these initiatives are expected to influence broader payer adoption and generate real-world evidence which could support the long-term sustainability of coverage. The OMA urges all stakeholders (patients, clinicians, and policymakers) to support the full and robust implementation of these new policies to ensure equitable access to comprehensive obesity care.

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About the Obesity Medicine Association

The Obesity Medicine Association is the largest organization of clinicians dedicated to the clinical treatment of the disease of obesity. OMA provides accredited education, clinical tools, and resources to healthcare providers in obesity medicine. Visit obesitymedicine.org to learn more.

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