Trump deals with Lilly, Novo Nordisk could broaden obesity drug access

President Donald Trump on Thursday struck landmark deals with Eli Lilly and Novo Nordisk that could mark a turning point in how many people can access their costly blockbuster obesity drugs. 

Under the agreements, Medicare will start covering GLP-1s for obesity for certain patients for the first time beginning in mid-2026 – a shift that will open access to millions of older adults and could spur 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 into coverage. 

Obesity drug coverage among state Medicaid plans, employers and other private insurers remains spotty due to the $1,000 or more monthly list prices of existing GLP-1s, including Eli Lilly’s obesity injection Zepbound and Novo Nordisk’s competitor Wegovy. 

The limited insurance coverage has blocked out patients who can’t afford their hefty price tags. That lack of access has led to mounting pressure on health plans and the government to expand coverage — and the government agreements with drugmakers could mark a major shift.

“I think it’ll start with the government, start with Medicare, and the insurers will quickly follow,” Nick Fabrizio, an associate teaching professor in Cornell’s health policy program, told CNBC. “I do think that’s coming.”

“This is a great step towards trying to address a chronic and serious issue, and for those patients who may feel like they have no hope,” he said.

Roughly 8 to 9 million people in the U.S. are using GLP-1s, Eli Lilly CEO David Ricks said at a briefing with reporters on Thursday. The added Medicare coverage under the deal could bring in as many as 40 million new eligible patients, and prompt more commercial plans to cover the medicines, 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 out-of-pocket cost of existing injections and upcoming pills could range from $50 to $350 starting next year, depending on the dosage and insurance coverage a patient has. 

Still, there is a law prohibiting 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 the spring of 2026 under a temporary legal mechanism. It would be voluntary for Medicare prescription drug plans, so “it may be possible that a few plans do not participate, but I would expect almost all do,” he said. 

But Ricks said that it will transition into a formal so-called Center for Medicare and Medicaid Innovation pilot program in 2027, which means it will be mandatory for all Medicare Part D plans.

“So we expect broad coverage in all plans both in 2026 and beyond,” he said.

Likely the most notable feature of the deals 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 deals, Eli Lilly and Novo Nordisk agreed to cut the price Medicare and Medicaid pay for GLP-1s to $245 per month. In Medicare specifically, certain patients will pay a copay of $50 per month for all approved uses of injectable and oral GLP-1 drugs, including diabetes and obesity treatment.

But the Trump administration is putting some constraints on which Medicare beneficiaries will be eligible to receive GLP-1s for obesity and cardiovascular and metabolic benefits. People who qualify include patients with a body mass index of 27 or above with prediabetes or established cardiovascular disease; people with a BMI of 30 or more with 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 have obesity or are overweight with one related condition. In a note Thursday, Leerink Partners analyst David Risinger also said it’s unclear whether the government will allow patients to stay on a GLP-1 for obesity after their BMI levels drop. 

Even with those restrictions, “I think 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 said the eligibility criteria mean 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 in a note about Eli Lilly on Thursday. 

Lakdawalla added that while there isn’t clear evidence that private insurers will expand coverage on the heels of government plans, “it’s just optically harder for them to continue to constrain coverage when Medicare and Medicaid are covering them.” 

“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 ticked up slightly, but remains sparse: A May survey of more than 300 companies by the International Foundation of Employee Benefit Plans found that 36% provided coverage for GLP-1s for both weight loss and diabetes, up from 34% in 2024. 

Lakdawalla said the direct-to-consumer offerings under the deal could be useful for people who are underinsured, uninsured or may not have coverage for obesity medicines. Still, it’s unclear how many more patients the drugs will reach due to the offerings. 

Both Eli Lilly and Novo Nordisk have introduced lower cost options for their drugs for people paying in cash and purchasing the drugs directly through their websites. But the deals with Trump will give those patients 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 the next two years, according to senior Trump administration officials. Eli Lilly and Novo Nordisk both offered some GLP-1s on their direct-to-consumer platforms for up to $450 to $500 per month.

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 on Thursday said it would lower prices by $50 on its own direct-to-consumer platform, LillyDirect, which already offers Zepbound and other drugs at a discount to cash-paying patients. The multidose pen of Zepbound will be available for $299 per month at the lowest dose, with additional doses being priced up to $449 per month.

In terms of Medicaid, Cornell’s Fabrizio said states will likely want to start covering obesity drugs at the lower price point, “but the question is how will they pay for it?”

Around a dozen state Medicaid programs cover obesity drugs, according to 2024 estimates from KFF, a health policy research organization. While GLP-1s offer substantial health benefits to Medicaid beneficiaries, state programs are already facing constrained budgets and administrative demands.

Fabrizio added that raising taxes to cover the drugs “could be a sticky 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.