Two of President-elect Trump's top health nominees are on a collision course as the incoming administration faces a crucial decision on coverage for groundbreaking anti-obesity drugs.
Mehmet Oz, Trump’s pick to run the Centers for Medicare and Medicaid Services, has extolled the benefits of anti-obesity drugs such as Ozempic, pitching them on his show and social media channels.
“In general, I think the amount of good done by these medications by helping people lose weight and improve their cardiovascular system — and it might have long-term benefits in a lot of other areas as well where obesity causes inflammation — is massive,” Oz said in an Instagram video last year.
Oz's potential boss, Health and Human Services secretary nominee Robert F. Kennedy Jr., thinks the drugs are a scam, and the solution to obesity is to simply eat better.
“The first line of response should be lifestyle. It should be eating well, making sure that you don’t get obese,” Kennedy told CNBC’s Jim Cramer in an interview Dec. 12.
In an interview with Greg Gutfeld on Fox News in October, Kennedy suggested weight loss drugs were being pushed on to gullible Americans by foreign pharmaceutical companies that wouldn’t even market the drugs in their home countries.
Foreign companies are “counting on selling it to Americans because we’re so stupid and so addicted to drugs,” Kennedy said.
“If we just gave good food, three meals a day, to every man, woman and child in our country, we could solve the obesity and diabetes epidemic overnight,” he added.
Kennedy made similar comments in a post on the social platform X in September.
“When I’m working in the next administration, I will address our sick food system—and the corrupt government agencies—to help make our country healthy again,” he wrote. “In the meantime perhaps we should consider replanting the kitchen garden before sending more money to Denmark.”
Kennedy’s position is also seemingly at odds with newly prominent Trump adviser Elon Musk, who is co-lead of the "Department of Government Efficiency" (DOGE), a government advisory panel focused on cutting government spending. Musk previously credited Wegovy with helping him lose weight, and recently said the drugs need to be made more widely available.
“Nothing would do more to improve the health, lifespan and quality of life for Americans than making GLP inhibitors super low cost to the public,” Musk posted on X earlier this month. “Nothing else is even close.”
The widely different views among some of Trump's top advisers and Cabinet nominees set up a potential clash within the next administration, which will face a costly decision over whether to allow Medicare to cover the life-changing drugs.
Medicare is currently prohibited from covering weight loss drugs for anything other than treating conditions such as diabetes or heart disease. Currently, only 13 states cover GLP-1 drugs for obesity under Medicaid.
But a new proposal announced by the Biden administration in November would require Medicare and Medicaid coverage of weight loss drugs for people with obesity.
It's a move that could impact coverage for millions of Americans, and would be extremely popular. But it also comes with a price tag in the tens of billions of dollars, as anti-obesity drugs cost upward of $1,000 per month.
Authorizing coverage of anti-obesity medications in Medicare would increase federal spending by about $35 billion from 2026 to 2034, according to the Congressional Budget Office. It would apply to about 3.4 million people with Medicare and 4 million people with Medicaid.
It will be up to the Trump administration to decide whether to move forward with the plan.
“This is kind of a unique situation, in which the Biden administration is proposing this change and basically handing it off to the incoming Trump administration to finalize,” said Juliette Cubanski, deputy director of Medicare policy at the health policy research organization KFF.
“And I think it's an open question at this point as to what the incoming Trump administration will choose to do,” she said.
Cubanski said a final rule would likely be issued sometime in the late spring or early summer of 2025, making it one of the earliest decisions the new administration will face. Comments are due Jan. 27, just a week after the inauguration.
A final decision could likely be made by the White House, and the level of influence Oz or Kennedy will have on the process may depend on how quickly the Republican-controlled Senate will be able to confirm them.
There’s bipartisan interest in Congress in letting Medicare cover anti-obesity medications, but the price tag has been the biggest obstacle. With conservatives in power looking to slash spending next year, letting the administration make the decision would take the pressure off lawmakers.
The CBO’s analysis also did not look at the potential for additional savings that might come if, as widely expected, semaglutide-based drugs such as Ozempic and Wegovy are subject to Medicare drug price negotiations next year.
“The cost of expanding coverage has, I think, kind of stymied policymakers in those efforts. So this proposal certainly would take that problem away,” Cubanski said. “They wouldn't have to change the law. This would just be a reinterpretation of the existing statutory language.”
Christine Gallagher, the associate director for research and policy for the STOP Obesity Alliance, said she’s optimistic Trump and his potential health team are aware of the benefits of expanding coverage of anti-obesity drugs.
"These are not weight loss drugs anymore. These are medications that are designed for the treatment of obesity as a disease,” Gallagher said.
Gallagher said she has reason for optimism. She pointed to recent remarks where Kennedy seemed to soften his stance.
In his CNBC interview, Kennedy said anti-obesity drugs "have a place."
