US 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 | fake images
President Donald Trump reached historic agreements on Thursday with Eli Lilly and Nordisk That could mark a turning point in the number of people who can access its expensive and successful anti-obesity drugs.
Under the agreements, Medicare will begin covering GLP-1 for obesity for certain patients for the first time starting in mid-2026, a change that will open 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 reducing the prices that all state Medicaid programs will pay for GLP-1s, but it is up to states to opt into coverage.
Obesity drug coverage among state Medicaid plans, employers and other private insurers remains spotty due to monthly list prices of $1,000 or more for existing GLP-1s, including Eli Lilly's Zepbound obesity shot and Novo Nordisk's competitor Wegovy.
Limited insurance coverage has locked out patients who cannot afford its high prices. That lack of access has led to growing pressure on health plans and the government to expand coverage, and government deals with drug makers could mark 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 that's coming.”
“This is a big step in trying to address a serious, chronic problem, and for those patients who may feel like they have no hope,” he said.
About 8 million to 9 million people in the United States use LPG-1, Eli Lilly CEO David Ricks said in a briefing with reporters on Thursday. Additional Medicare coverage under the deal could attract up to 40 million new eligible patients and lead to 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 medications to access them by offering the treatments at a discount on the Trump administration's direct-to-consumer website, TrumpRx.gov.
The monthly out-of-pocket cost for existing injections and upcoming pills could range from $50 to $350 starting next year, depending on the dosage and the patient's insurance coverage.
Still, there is a law that prohibits Medicare from covering weight-loss drugs, so any changes would have to come from Congress. Eli Lilly's Ricks told reporters Thursday that, for now, the government will launch an initial pilot program in spring 2026 under a temporary legal mechanism. It would be voluntary for Medicare prescription drug plans, so “some plans may not participate, but I would expect almost all to do so,” he said.
But Ricks said it will become a formal pilot program called the Center for Medicare and Medicaid Innovation in 2027, meaning it will be required for all Medicare Part D plans.
“That's why we expect broad coverage across all plans both in 2026 and beyond,” he said.
Medicare coverage could be a game changer
Probably the most notable feature of the agreements is Medicare coverage of obesity drugs, as it will 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 reduce the price that Medicare and Medicaid pay for GLP-1 to $245 per month. Specifically in Medicare, certain patients will pay a copayment of $50 per month for all approved uses of injectable and oral GLP-1 medications, including the treatment of diabetes and obesity.
But the Trump administration is imposing some limitations on which Medicare beneficiaries will be eligible to receive GLP-1 for obesity and cardiovascular and metabolic benefits. Qualified individuals include patients with a body mass index of 27 or higher with prediabetes or established cardiovascular disease; people with a BMI of 30 or more with related health problems; or those with severe obesity or a BMI of 35 or more.
GLP-1 for weight loss is approved for a broader population: people who are obese or overweight with a related condition. In a note Thursday, Leerink Partners analyst David Risinger also said it's unclear whether the government will allow patients to continue taking a GLP-1 for obesity after their BMI levels drop.
Even with those 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 criteria mean 80% of the obese Medicare population could receive coverage for GLP-1, despite the limits.
“Today's deal will open significant access to obesity medications,” Schott said in a note on Eli Lilly on Thursday.
Lakdawalla added that while there is no clear evidence that private insurers will expand coverage after government plans, “it's just optically harder for them to continue to restrict coverage when Medicare and Medicaid cover them.”
“That will also put some pressure on expanding commercial coverage of these drugs,” Lakdawalla said.
GLP-1 coverage for obesity has increased slightly, but remains low: A May survey of more than 300 companies by the International Foundation for Employee Benefit Plans found that 36% provided coverage for GLP-1 for both weight loss and diabetes, up from 34% in 2024.
Medicaid and direct-to-consumer offerings could fill the gaps
Lakdawalla said direct-to-consumer offerings under the deal could be helpful to people who are underinsured, uninsured or may not have coverage for obesity medications. Still, it's unclear how many more patients the drugs will reach because of the deals.
Both Eli Lilly and Novo Nordisk have introduced lower-cost options for their medications for people who pay cash and purchase medications directly through their websites. But the deals with Trump will give those patients even bigger discounts.
At TrumpRx, the average monthly cost for Wegovy, Zepbound and other injectable LPG-1 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-1s on their direct-to-consumer platforms for up to $450 to $500 a month.
Initial doses of Eli Lilly and Novo Nordisk's obesity pills, which are expected to hit the market next year, will be $149 a month on TrumpRx, Medicare and Medicaid.
Eli Lilly said Thursday it would cut prices by $50 on its own direct-to-consumer platform, LillyDirect, which already offers Zepbound and other discounted drugs to patients who pay cash. Zepbound's multidose pen will be available for $299 per month at the lowest dose, with additional doses priced up to $449 per month.
In terms of Medicaid, Cornell's Fabrizio said states will probably want to start covering obesity drugs at a lower price, “but the question is how they will pay for them.”
About a dozen state Medicaid programs cover obesity medications, according to 2024 estimates from KFF, a health policy research organization. While GLP-1s offer important health benefits to Medicaid beneficiaries, state programs already face limited budgets and administrative demands.
Fabrizio added that raising taxes to cover medications “could be a sensitive 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 uptake.
