Medicare to Cover Obesity Drugs Starting at $149 Under White House Deals

Obesity drugs will soon be accessible through Medicare at reduced rates, with prices starting at $149. This development arises from two agreements made by the Trump administration with leading pharmaceutical companies Eli Lilly and Novo Nordisk.

Medicare Coverage Expansion for Obesity Drugs

The recent initiative is part of ongoing efforts to lower prescription drug costs. Under these agreements, the companies will also offer price reductions for various drugs in Medicaid. The terms include tariff breaks for imported medications and accelerated regulatory reviews for specific products.

Pricing Structure and Consumer Impact

• The current price range for these obesity medications is between $1,000 and $1,350.
• Consumers purchasing injectable GLP-1 medications will start paying an average of $350 per month.
• Prices for these medications are set to decrease to approximately $250 over the next couple of years.
• If approved by the FDA, oral GLP-1 tablets will be available at a starting price of $149.

These prices will be effective once the TrumpRx website launches in early 2026. Currently, Novo Nordisk offers cash options for Ozempic and Wegovy at $499 per month, while Lilly’s Zepbound starts at $349 per month.

Eligibility Criteria

Eligible Medicare enrollees will have a copay of $50 for specific GLP-1 medications that address obesity and diabetes. The prices Medicare pays for these medications will be reduced to $245, facilitating expanded access to obesity treatments. This expansion particularly targets individuals with prediabetes, cardiovascular conditions, obesity, and severe high blood pressure.

• Approximately 10% of Medicare enrollees may qualify for expanded access through these deals.
• The arrangements indicate a shift toward recognizing obesity as a chronic disease.

Future of Obesity Drug Access and Related Initiatives

Additionally, Eli Lilly and Novo Nordisk plan to offer these medications at lower rates to state Medicaid programs, though the timeline will vary by state. As of August 2024, 13 states provided coverage for these costly drugs, although North Carolina recently ceased this coverage.

In his second term, President Trump has focused on establishing drug prices in the US in line with those in other developed countries. The current strategy emphasizes voluntary price reductions from drugmakers. The president has highlighted the increasing popularity of GLP-1 medications for weight loss and chronic disease management.

As discussions continue, there is potential for significant savings for both Medicare and its enrollees. The next phase includes ongoing price negotiations for GLP-1 drugs, expected to yield additional benefits for the program.