Trump deals with Lilly, Novo Nordisk could broaden obesity drug access
U.S. President Donald Trump makes an announcement in the Oval Office of the White House in Washington, DC, on November 6, 2025.
Andrew Caballero-Reynolds | AFP | Getty Images
President Donald Trump signed major agreements on Thursday Eli Lilly And Novo Nordisk This could be a turning point in how many people will have access to expensive, blockbuster obesity drugs.
Under the agreements, Medicare would for the first time begin covering GLP-1s for obesity for certain patients starting in mid-2026, which would provide access to millions of older adults and could encourage 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 whether to offer coverage.
Obesity drug coverage among them state Medicaid plansEmployers and other private insurers remain unregulated by list prices of $1,000 or more per month for existing GLP-1s, including Eli Lilly’s obesity injection Zepbound and Novo Nordisk’s rival Wegovy.
Limited insurance coverage prevented patients from being able to afford the hefty price tags. This lack of access has led to increased pressure on health plans and the government to expand coverage, and the government’s agreements with drug manufacturers could signal a major shift.
“I think it will start with the government, it will 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 for patients who have a chronic and serious problem and feel like they have no hope,” he said.
About 8 to 9 million people in the United States use GLP-1, Eli Lilly CEO David Ricks said in a briefing with reporters Thursday. He said the Medicare coverage added under the deal could bring up to 40 million new eligible patients and encourage more commercial plans to cover the drugs.
The deals could also make treatments available at a discount on the Trump administration’s direct-to-consumer website, eliminating the inability of many patients with limited or no insurance coverage for obesity medications to access them. TrumpRx.gov.
The monthly out-of-pocket cost of current injections and future medications could range from $50 to $350 starting next year, depending on the dosage and insurance coverage the patient has.
Still, there is a law that prohibits Medicare from covering weight-loss drugs, so any change would have to come from Congress. The government will launch the first pilot program in spring 2026 under an interim legal mechanism for now, Eli Lilly’s Ricks told reporters Thursday. Medicare prescription drug plans will be voluntary, so “it may be possible that a few plans will not participate, but I would expect almost all of them to participate,” he said.
But it will transition to a formal pilot program called the Center for Medicare and Medicaid Innovation in 2027, which means it will be mandatory for all Medicare Part D plans, Ricks said.
“So we expect broad coverage of all plans, both in 2026 and beyond,” he said.
Medicare coverage could be a big change
Perhaps the most notable feature of the agreements is that Medicare covers obesity drugs, as it would allow the treatments to reach new patients in the program and could lead to broader private insurance coverage.
Under the agreements, Eli Lilly and Novo Nordisk agreed to lower the price Medicare and Medicaid pay for GLP-1s to $245 per month. Particularly on Medicare, some patients will pay a co-pay of $50 per month for all approved uses of injectable and oral GLP-1 drugs, including treating diabetes and obesity.
However, the Trump administration is placing some restrictions on how Medicare beneficiaries may qualify to receive GLP-1 for obesity, cardiovascular and metabolic benefits. Those eligible include patients with a body mass index of 27 or higher, prediabetes, or established cardiovascular disease; People with a BMI of 30 or more and related health problems; 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 have obesity or are overweight with a related condition. It’s also unclear whether the government will allow patients to continue using GLP-1 for obesity after their BMI levels drop, Leerink Partners analyst David Risinger said in a note published Thursday.
Despite these limitations, “I think in practice it will still cover a fair number of people,” said Darius Lakdawalla, chief scientific officer of the Schaeffer Center at the University of Southern California.
JPMorgan analyst Chris Schott said the eligibility criteria mean 80% of the obese population in Medicare could be covered by GLP-1, despite the limitations.
“Today’s agreement will provide meaningful access to obesity medications,” Schott said in a memo about Eli Lilly on Thursday.
Lakdawalla added that while there’s no clear evidence that private insurers will expand coverage on the heels of government plans, “it’s optically more difficult to continue restricting coverage when Medicare and Medicaid are covering them.”
“This will put some pressure on the commercial scope of these drugs to expand as well,” Lakdawalla said.
GLP-1 coverage for obesity has increased slightly but remains rare: A May survey A survey of more than 300 companies by the International Foundation for Employee Benefit Plans found that 34% provide GLP-1 coverage for both weight loss and diabetes by 2024.
Medicaid and direct-to-consumer offerings could fill gaps
Lakdawalla said the direct-to-consumer offerings under the agreement could be helpful to people who are uninsured, uninsured or not covered by obesity medications. Still, it is unclear how many more patients the drugs will reach due to the offers.
Both Eli Lilly and Novo Nordisk offered lower-cost options for their drugs for people who paid cash and purchased drugs directly through their websites. But the deals with Trump will give these patients even bigger discounts.
The average monthly cost at TrumpRx for Wegovy, Zepbound and other injectable GLP-1s will start at $350 and drop to $250 over the next two years, according to senior Trump administration officials. Eli Lilly and Novo Nordisk offered some GLP-1 on their direct-to-consumer platforms for as much as $450 to $500 per month.
Starting doses of obesity pills from Eli Lilly and Novo Nordisk, expected to become available next year, will cost $149 per month through TrumpRx, Medicare and Medicaid.
Eli Lilly on Thursday said it would drop prices by $50 on its direct-to-consumer platform, LillyDirect, which already offers Zepbound and other drugs at a discount to patients who pay cash. The multi-dose Zepbound pen will be available for $299 per month for the lowest dose, with additional doses costing up to $449 per month.
From a Medicaid standpoint, states will likely want to start covering obesity drugs at lower prices, Cornell’s Fabrizio said, “but the question is, how are they going to pay for it?”
Nearly a dozen state Medicaid programs will cover obesity drugs by 2024 predictions From KFF, a health policy research organization. While GLP-1s offer significant health benefits to Medicaid beneficiaries, state programs currently face tight budgets and administrative demands.
Raising taxes to pay for drugs “could be a sticky issue,” Fabrizio added.
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 uptake.
