U.S. President Donald Trump makes an announcement in the Oval Office of the White House in Washington, DC, November 6, 2025.
Andrew Caballero-Reynolds | AFP | Getty Images
President Donald Trump reached historic agreements Thursday with Elie Lilly And Novo Nordisk it could mark a turning point in how many people can access their expensive obesity drugs.
Under the agreements, Medicare will begin covering obesity GLP-1s for some patients for the first time starting in mid-2026 — a change that will open access to millions of seniors and could prompt more employers and other private insurers to follow suit, some experts said. Novo Nordisk and Eli Lilly are also lowering the prices that all state Medicaid programs will pay for GLP-1s, but it’s up to states to opt in on coverage.
Obesity drug coverage among state Medicaid plans, employers and other private insurers remains spotty because of monthly list prices of $1,000 or more of existing GLP-1s, including Eli Lilly’s obesity injection, Zepbound, and Novo Nordisk competitor Wegovy.
Limited insurance coverage has excluded patients who cannot afford to pay high prices. This lack of access has led to growing pressure on health plans and the government to expand coverage — and government deals with drugmakers could mark a major shift.
“I think it will start with government, start with Medicare, and insurers will quickly follow,” Nick Fabrizio, an associate professor in Cornell’s health policy program, told CNBC. “I think it’s coming.”
“This is a big step forward in trying to solve a chronic and serious problem, and for patients who may feel like they have no hope,” he said.
In the United States, about 8 to 9 million people use GLP-1s, Eli Lilly CEO David Ricks said Thursday in a briefing with reporters. The additional Medicare coverage under the deal could attract up to 40 million new eligible patients and spur more commercial plans to cover the drugs, he said.
The deals could also address the inability of many patients with limited or no insurance coverage for obesity drugs to access them, by offering the treatments at a discount on the Trump administration’s direct-to-consumer website, TrumpRx.gov.
The monthly cost of existing injections and upcoming pills could range from $50 to $350 starting next year, depending on the dosage and insurance coverage the patient has.
Still, there is a law prohibiting Medicare from covering weight-loss drugs, so any changes would have to come from Congress. Ricks of Eli Lilly told reporters Thursday that for now, the government will launch a first pilot program in spring 2026 under a temporary legal mechanism. It would be voluntary for Medicare prescription drug plans, so “it’s possible that a few plans won’t participate, but I would expect almost all of them to,” he said.
But Ricks said it will move to a formal so-called Center for Medicare and Medicaid Innovation pilot program in 2027, meaning it will be mandatory for all Medicare Part D plans.
“So we expect broad coverage across all plans in 2026 and beyond,” he said.
Medicare coverage could be a sea change
Perhaps the most notable feature of these deals is Medicare coverage of obesity drugs, as it will allow treatments to reach new patients in the program and could lead to broader private insurance coverage.
As part of the agreements, Eli Lilly and Novo Nordisk agreed to reduce the price paid by Medicare and Medicaid for GLP-1s to $245 per month. In Medicare specifically, some patients will pay a $50 per month copay for all approved uses of injectable and oral GLP-1 medications, including treatment of diabetes and obesity.
But the Trump administration is placing some constraints on which Medicare beneficiaries will be eligible for GLP-1s for obesity and cardiovascular and metabolic benefits. Eligible individuals include patients with a body mass index of 27 or greater and prediabetes or established cardiovascular disease; people with a BMI of 30 or more and suffering from related health conditions; or those with severe obesity or a BMI of 35 and above.
GLP-1s for weight loss are approved for a broader population: people who are obese or overweight with a related condition. In a note released Thursday, Leerink Partners analyst David Risinger also said it was unclear whether the government would allow patients to remain on GLP-1 for obesity after their BMI dropped.
Even with these restrictions, “I think in practice it will still cover a good number of people,” said Darius Lakdawalla, scientific director of the Schaeffer Center at the University of Southern California.
JPMorgan analyst Chris Schott said the eligibility requirements mean 80% of Medicare’s obese population could receive coverage for GLP-1s, despite the limits.
“Today’s agreement will open meaningful access to obesity medications,” Schott said in a note about Eli Lilly on Thursday.
Lakdawalla added that while there is no clear evidence that private insurers will expand coverage on the heels of government plans, “it’s simply more difficult for them to continue to limit coverage when Medicare and Medicaid cover them.”
“This is going to put some pressure on commercial coverage of these drugs to expand as well,” Lakdawalla said.
GLP-1 coverage for obesity has increased slightly, but remains rare: A May survey of more than 300 companies by the International Employee Benefit Plan Foundation found that 36% offered GLP-1 coverage for weight loss and diabetes, up from 34% in 2024.
Direct-to-consumer Medicaid offerings could fill gaps
Lakdawalla said direct-to-consumer offerings under the deal could be helpful to people who are underinsured, uninsured or who don’t have coverage for obesity medications. Still, it’s unclear how many additional patients the drugs will reach through these deals.
Eli Lilly and Novo Nordisk have both introduced less expensive options for their medications for people paying cash and purchasing the medications directly through their websites. But the deals with Trump will give these patients even deeper discounts.
On TrumpRx, the average monthly cost of Wegovy, Zepbound and other GLP-1 injectables will start at $350 and drop to $250 over the next two years, according to senior Trump administration officials. Both Eli Lilly and Novo Nordisk offered GLP-1s on their direct-to-consumer platforms for $450 to $500 per month.
Initial doses of obesity pills from Eli Lilly and Novo Nordisk — expected to hit the market next year — will cost $149 per month on TrumpRx, Medicare and Medicaid.
Eli Lilly announced Thursday that it would reduce prices by $50 on its own direct-to-consumer platform, LillyDirect, which already offers Zepbound and other drugs at a discount to patients paying cash. Zepbound’s multidose pen will be available for $299 per month at the lowest dose, with additional doses going up to $449 per month.
When it comes to Medicaid, Cornell’s Fabrizio said states will likely want to start covering obesity drugs at a lower price, “but the question is how are they going to pay for it?”
About a dozen state Medicaid programs cover obesity medications, according to 2024 estimates from KFF, a health policy research organization. While GLP-1s provide substantial health benefits to Medicaid beneficiaries, public programs already face budgetary constraints and limited administrative requirements.
Fabrizio added that raising taxes to cover drugs “could be a tricky issue.”
Still, JPMorgan’s Schott said offering lower prices to Medicaid programs could lead to a “significant increase in coverage” in that channel, where Zepbound has very limited adoption.