US President Donald Trump makes an announcement within the Oval Workplace of the White Home in Washington, DC on Nov. 6, 2025.
Andrew Caballero-Reynolds | AFP | Getty Photographs
President Donald Trump on Thursday struck landmark offers with Eli Lilly and Novo Nordisk that would mark a turning level in how many individuals can entry their pricey blockbuster weight problems medicine.
Underneath the agreements, Medicare will begin masking GLP-1s for weight problems for sure sufferers for the primary time starting in mid-2026 – a shift that may open entry to hundreds of thousands of older adults and will spur extra employers and different personal insurers to observe swimsuit, some specialists mentioned. Novo Nordisk and Eli Lilly are additionally reducing the costs that every one state Medicaid packages pays for GLP-1s, but it surely’s as much as states to decide into protection.
Weight problems drug protection amongst state Medicaid plans, employers and different personal insurers stays spotty because of the $1,000 or extra month-to-month listing costs of present GLP-1s, together with Eli Lilly’s weight problems injection Zepbound and Novo Nordisk’s competitor Wegovy.
The restricted insurance coverage protection has blocked out sufferers who cannot afford their hefty worth tags. That lack of entry has led to mounting stress on well being plans and the federal government to broaden protection — and the federal government agreements with drugmakers might mark a serious shift.
“I feel it’s going to begin with the federal government, begin with Medicare, and the insurers will rapidly observe,” Nick Fabrizio, an affiliate educating professor in Cornell’s well being coverage program, informed CNBC. “I do suppose that is coming.”
“It is a nice step in the direction of attempting to deal with a persistent and severe subject, and for these sufferers who might really feel like they don’t have any hope,” he mentioned.
Roughly 8 to 9 million individuals within the U.S. are utilizing GLP-1s, Eli Lilly CEO David Ricks mentioned at a briefing with reporters on Thursday. The added Medicare protection underneath the deal might herald as many as 40 million new eligible sufferers, and immediate extra business plans to cowl the medicines, he mentioned.
The offers might additionally handle the lack of many sufferers with restricted or no insurance coverage protection for weight problems medicine to entry them, by providing the remedies at a reduction on the Trump administration’s direct-to-consumer web site, TrumpRx.gov.
The month-to-month out-of-pocket value of present injections and upcoming tablets might vary from $50 to $350 beginning subsequent yr, relying on the dosage and insurance coverage protection a affected person has.
Nonetheless, there’s a regulation prohibiting Medicare from masking weight reduction medicine, so any adjustments must come from Congress. Eli Lilly’s Ricks informed reporters Thursday that for now, the federal government will launch an preliminary pilot program within the spring of 2026 underneath a short lived authorized mechanism. It might be voluntary for Medicare prescription drug plans, so “it could be potential that a number of plans don’t take part, however I might anticipate nearly all do,” he mentioned.
However Ricks mentioned that it’s going to transition into a proper so-called Middle for Medicare and Medicaid Innovation pilot program in 2027, which suggests will probably be obligatory for all Medicare Half D plans.
“So we anticipate broad protection in all plans each in 2026 and past,” he mentioned.
Medicare protection may very well be a sea change
Probably essentially the most notable function of the offers is Medicare protection of weight problems medicine, as it should enable the remedies to achieve new sufferers in this system and will result in broader personal insurance coverage protection.
Underneath the offers, Eli Lilly and Novo Nordisk agreed to chop the value Medicare and Medicaid pay for GLP-1s to $245 per 30 days. In Medicare particularly, sure sufferers pays a copay of $50 per 30 days for all accepted makes use of of injectable and oral GLP-1 medicine, together with diabetes and weight problems therapy.
However the Trump administration is placing some constraints on which Medicare beneficiaries will likely be eligible to obtain GLP-1s for weight problems and cardiovascular and metabolic advantages. Individuals who qualify embody sufferers with a physique mass index of 27 or above with prediabetes or established heart problems; individuals with a BMI of 30 or extra with associated well being circumstances; or these with extreme weight problems, or a BMI of 35 and above.
GLP-1s for weight reduction are accepted for a broader inhabitants: individuals who have weight problems or are chubby with one associated situation. In a word Thursday, Leerink Companions analyst David Risinger additionally mentioned it is unclear whether or not the federal government will enable sufferers to remain on a GLP-1 for weight problems after their BMI ranges drop.
Even with these restrictions, “I feel in observe, it is nonetheless going to cowl a good variety of individuals,” mentioned Darius Lakdawalla, chief scientific officer on the College of Southern California’s Schaeffer Middle.
JPMorgan analyst Chris Schott mentioned the eligibility standards imply 80% of the overweight inhabitants in Medicare might obtain protection for GLP-1s, regardless of the boundaries.
“At present’s deal will open up significant entry to weight problems medicine,” Schott mentioned in a word about Eli Lilly on Thursday.
Lakdawalla added that whereas there is not clear proof that personal insurers will broaden protection on the heels of presidency plans, “it is simply optically tougher for them to proceed to constrain protection when Medicare and Medicaid are masking them.”
“That is going to exert some stress for business protection of those medicine to broaden as nicely,” Lakdawalla mentioned.
Protection for GLP-1s for weight problems has ticked up barely, however stays sparse: A Might survey of greater than 300 corporations by the Worldwide Basis of Worker Profit Plans discovered that 36% offered protection for GLP-1s for each weight reduction and diabetes, up from 34% in 2024.
Medicaid, direct-to-consumer choices might fill gaps
Lakdawalla mentioned the direct-to-consumer choices underneath the deal may very well be helpful for people who find themselves underinsured, uninsured or might not have protection for weight problems medicines. Nonetheless, it is unclear what number of extra sufferers the medicine will attain because of the choices.
Each Eli Lilly and Novo Nordisk have launched decrease value choices for his or her medicine for individuals paying in money and buying the medicine instantly by their web sites. However the offers with Trump will give these sufferers even larger reductions.
On TrumpRx, the common month-to-month value for Wegovy, Zepbound and different injectable GLP-1s will begin at $350 and drop to $250 throughout the subsequent two years, based on senior Trump administration officers. Eli Lilly and Novo Nordisk each supplied some GLP-1s on their direct-to-consumer platforms for as much as $450 to $500 per 30 days.
Beginning doses of weight problems tablets from Eli Lilly and Novo Nordisk — anticipated to hit the market subsequent yr — will likely be $149 per 30 days on TrumpRx, Medicare and Medicaid.
Eli Lilly on Thursday mentioned it might decrease costs by $50 by itself direct-to-consumer platform, LillyDirect, which already presents Zepbound and different medicine at a reduction to cash-paying sufferers. The multidose pen of Zepbound will likely be out there for $299 per 30 days on the lowest dose, with further doses being priced as much as $449 per 30 days.
When it comes to Medicaid, Cornell’s Fabrizio mentioned states will probably need to begin masking weight problems medicine on the lower cost level, “however the query is how will they pay for it?”
Round a dozen state Medicaid packages cowl weight problems medicine, based on 2024 estimates from KFF, a well being coverage analysis group. Whereas GLP-1s provide substantial well being advantages to Medicaid beneficiaries, state packages are already dealing with constrained budgets and administrative calls for.
Fabrizio added that elevating taxes to cowl the medicine “may very well be a sticky subject.”
Nonetheless, JPMorgan’s Schott mentioned providing decrease costs to Medicaid packages might result in a “important enhance in protection” in that channel, the place Zepbound has very restricted uptake.
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