Medicare launches pilot program expanding access to GLP-1 drugs

CMS has initiated a pilot program to expand Medicare coverage for GLP-1 receptor agonists (e.g., semaglutide, tirzepatide) for obesity and weight-related comorbidities. The pilot relaxes prior criteria that limited coverage to patients with type 2 diabetes, opening access for beneficiaries with obesity and conditions like hypertension or sleep apnea. This follows mounting pressure from clinicians and patient advocates over restrictive Medicare coverage policies for anti-obesity medications. Billing teams should update their prior authorization workflows for Medicare patients seeking GLP-1 therapy, as the new coverage criteria take effect for the pilot population immediately. Verify patient eligibility and diagnosis codes (E66.*, I10, G47.33) against the pilot's published clinical criteria before submitting claims.