A bold move by President Trump could revolutionize access to obesity medications for millions of Americans. But here's where it gets controversial...
On Thursday, President Trump announced groundbreaking agreements with pharmaceutical giants Eli Lilly and Novo Nordisk, potentially marking a turning point in the availability of their costly obesity drugs.
The deals include a significant shift: Medicare, the government-run health insurance program for older adults, will start covering GLP-1 medications for obesity beginning in mid-2026. This move is expected to open doors for millions of seniors and could prompt private insurers to follow suit, according to experts.
Novo Nordisk and Eli Lilly have also agreed to lower prices for GLP-1s, but the decision to cover these medications rests with individual states' Medicaid programs.
Currently, access to obesity drugs is limited due to their high monthly costs, often exceeding $1,000. This has left many patients unable to afford these medications, leading to growing pressure on health plans and the government to expand coverage.
"I think it'll start with the government, and insurers will quickly follow," said Nick Fabrizio, an associate professor at Cornell's health policy program. "This is a great step towards addressing a serious chronic issue and offering hope to patients."
Eli Lilly CEO David Ricks estimates that the added Medicare coverage could bring in up to 40 million new eligible patients, potentially prompting commercial plans to cover these medications as well.
The agreements also address the issue of uninsured or underinsured patients by offering discounted treatments on the Trump administration's direct-to-consumer website, TrumpRx.gov.
Monthly out-of-pocket costs for existing injections and upcoming pills are expected to range from $50 to $350, depending on dosage and insurance coverage.
However, there's a catch: Medicare is prohibited by law from covering weight loss drugs. Any changes would require congressional action. For now, the government will launch a pilot program in spring 2026 under a temporary legal mechanism, with participation being voluntary for Medicare prescription drug plans.
But Eli Lilly's Ricks expects this to transition into a mandatory Center for Medicare and Medicaid Innovation pilot program in 2027, covering all Medicare Part D plans.
"We expect broad coverage in all plans both in 2026 and beyond," Ricks said.
The most notable aspect of these deals is the Medicare coverage for obesity drugs, which could lead to broader private insurance coverage. Under the agreements, Eli Lilly and Novo Nordisk will reduce the price Medicare and Medicaid pay for GLP-1s to $245 per month.
In Medicare, certain patients will pay a $50 copay per month for all approved uses of injectable and oral GLP-1 drugs, including diabetes and obesity treatment. However, the Trump administration has placed restrictions on which Medicare beneficiaries are eligible for GLP-1s for obesity and cardiovascular and metabolic benefits.
These restrictions include patients with a BMI of 27 or above with prediabetes or established cardiovascular disease, those with a BMI of 30 or more with related health conditions, and individuals with severe obesity (BMI of 35 and above).
GLP-1s for weight loss are approved for a broader population: people who are obese or overweight with one related condition. It remains unclear whether the government will allow patients to continue using GLP-1s for obesity after their BMI levels drop.
"In practice, it's still going to cover a fair number of people," said Darius Lakdawalla, chief scientific officer at the University of Southern California's Schaeffer Center.
JPMorgan analyst Chris Schott estimates that 80% of the obese population in Medicare could receive coverage for GLP-1s, despite the limits.
"Today's deal will open up meaningful access to obesity drugs," Schott said.
Lakdawalla added that while there's no clear evidence that private insurers will expand coverage, it will be harder for them to continue constraining coverage when Medicare and Medicaid are covering these medications.
"That's going to exert some pressure for commercial coverage of these drugs to expand as well," Lakdawalla said.
Coverage for GLP-1s for obesity has slightly increased, but remains sparse. A May survey by the International Foundation of Employee Benefit Plans found that only 36% of companies provided coverage for GLP-1s for weight loss and diabetes, up from 34% in 2024.
The direct-to-consumer offerings under the deal could benefit those who are underinsured or uninsured, but it's unclear how many more patients will be reached. Both Eli Lilly and Novo Nordisk have introduced lower-cost options for their drugs, and the deals with Trump will offer even bigger discounts.
On TrumpRx, the average monthly cost for Wegovy, Zepbound, and other injectable GLP-1s will start at $350 and drop to $250 within two years. Starting doses of obesity pills from Eli Lilly and Novo Nordisk, expected to hit the market next year, will be $149 per month on TrumpRx, Medicare, and Medicaid.
Eli Lilly has announced it will lower prices by $50 on its direct-to-consumer platform, LillyDirect, which already offers discounted medications to cash-paying patients.
As for Medicaid, states will likely want to cover obesity drugs at the lower price point, but the question remains: How will they pay for it?
According to KFF, a health policy research organization, around a dozen state Medicaid programs currently cover obesity drugs. While GLP-1s offer substantial health benefits, state programs face budget constraints and administrative demands.
"Raising taxes to cover these drugs could be a sticky issue," Fabrizio said.
Despite these challenges, offering lower prices to Medicaid programs could lead to a significant increase in coverage, especially for medications like Zepbound, which currently have very limited uptake.
And this is the part most people miss: These deals have the potential to transform access to obesity medications, but they also raise important questions about the role of government and private insurers in healthcare.
What do you think? Should the government play a larger role in expanding access to essential medications? Or is this a step too far? Let's discuss in the comments!
