Medicare to cover obesity drugs for certain groups next year

By Wire Reports

Medicare will cover GLP-1 weight loss drugs for specific patient groups, beginning in mid-2026, under a deal the Trump administration struck with drugmakers Eli Lilly and Novo Nordisk.

The deal also includes lower prices for GLP-1 drugs for Americans who use cash to buy them through a new government website. That website is expected to launch next year and will allow people to buy drugs directly from companies.

Politico reported that about 10% of Medicare beneficiaries will be eligible for expanded access to GLP-1 medications.

Medicare doesn’t cover GLP-1 drugs solely for fighting obesity. It allows coverage only for people who have obesity paired with health issues such as diabetes or cardiovascular issues. The new obesity drug coverage will be enabled through a pilot program designed to cover a majority of beneficiaries under Medicare Part D.

Under the agreements, the monthly out-of-pocket cost of popular injections and pills that are currently under development could range from $50 to $350 starting next year, depending on the dosage and the patient’s insurance coverage.

3 eligible groups for GLP-1 coverage

Patients eligible for GLP-1 coverage will fall into three groups.

Those who are overweight — with a body mass index greater than 27 — with prediabetes or established cardiovascular disease.
Those with obesity – with a BMI greater than 30 – and uncontrolled hypertension, kidney disease or heart failure.
Patients with severe obesity, or anyone with a BMI greater than 35.

The specific prices Americans will pay, and when those price changes will kick in, will vary based on where people get their prescriptions — Medicare, Medicaid or through a direct-to-consumer program.

Eli Lilly CEO David Ricks said the administration plans to launch a voluntary pilot program for Medicare in the spring. While a few Medicare Part D plans may not participate, the drugmaker executive said he expects “almost all” will do so.

Then, starting in 2027, that program will become mandatory, according to Ricks.

For Medicare and Medicaid, drugs like Ozempic, Wegovy, Mounjaro and Zepbound will cost the insurance programs $245 a month. Medicare beneficiaries will only be responsible for a $50 copay, the White House said, and Americans on Medicaid generally pay little to no cost for prescription drugs.

For pill versions of the drugs, which are new versions of the medication that first need to face FDA approval, the price could be as low as $149 to Medicare and Medicaid.

Novo Nordisk asked the FDA to approve an oral version of Wegovy in May, and Eli Lilly plans to submit an application for its weight-loss pill candidate to the agency by the end of the year.

Patients also will be able to get GLP-1s on direct-to-consumer platforms at steeper discounts than they already receive through drugmakers’ existing sites.

On TrumpRx – the government’s direct-to-consumer platform for buying prescription drugs with cash expected to launch next year – the average monthly cost for Wegovy, Zepbound and other injectable GLP-1s will start at $350 and drop to $250 within the next two years, senior administration officials told NBC News.