Trump’s deals with Lilly and Novo Nordisk could expand access to obesity drugs

President Donald Trump on Thursday concluded historic agreements with… Eli Lilly and Novo Nordisk This could mark a turning point in the number of people who have access to expensive obesity medications.

Under the agreements, Medicare will begin covering GLP-1 obesity treatments for some patients for the first time starting in mid-2026 — a shift that will open access to millions of seniors 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 all state Medicaid programs will pay for GLP-1s, but it’s up to states to choose 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 injection and Novo Nordisk’s competitor Wegovy.

Limited insurance coverage has shut out patients who cannot afford their exorbitant prices. This lack of access has put increasing pressure on health plans and the government to expand coverage — and government agreements with drug makers could represent a major shift.

“I think it will start with the government, start with Medicare, and insurance companies will quickly follow,” Nick Fabrizio, an assistant teaching professor in the Health Policy Program at Cornell University, told CNBC. “I think this is coming.”

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

Nearly 8 to 9 million people in the United States use GLP-1s, Eli Lilly CEO David Rex said in a press conference Thursday. Additional Medicare coverage under the deal could bring in as many as 40 million new eligible patients and incentivize more commercial plans to cover the drugs, he said.

These 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 cost of the current injections and upcoming tablets could range from $50 to $350 starting next year, depending on the dose and the insurance coverage the patient has.

However, there is still a law prohibiting Medicare from covering weight-loss drugs, so any changes would have to come from Congress. For now, the government will launch an initial pilot program in the spring of 2026 under a temporary legal mechanism, Eli Lilly’s Rex told reporters on Thursday. It would be voluntary for Medicare prescription drug plans, so “it’s possible that some plans won’t participate, but I expect almost all of them will,” he said.

But Rex said it will move to what’s called a formal Center for Medicare and Medicaid Innovation pilot program in 2027, meaning it will be mandatory for all Medicare Part D plans.

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

The most notable feature of these deals is likely to be Medicare’s 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 those deals, Eli Lilly and Novo Nordisk agreed to reduce the price Medicare and Medicaid pay for GLP-1s to $245 per month. In Medicare specifically, some patients will pay a copayment of $50 per month for all approved uses of injectable and oral GLP-1 drugs, including treatment of diabetes and obesity.

But the Trump administration is placing some restrictions on which Medicare beneficiaries will be eligible for GLP-1 for obesity treatment and cardiovascular and metabolic benefits. Eligible individuals include patients with a BMI of 27 or greater and suffering from diabetes or cardiovascular disease. People with a BMI of 30 or more and related health conditions; Or those who are obese, or have a BMI of 35 and above.

GLP-1s are approved for weight loss for a wide range of populations: people who are obese or overweight with at least one related condition. In a note Thursday, Leerink Partners analyst David Reisinger said it was unclear whether the government would allow patients to continue taking GLP-1 for obesity after their BMI levels drop.

Even with these limitations, “I think in practice, it would still cover a fair number of people,” said Darius Lakdawala, chief scientific officer at the USC Schaefer Center.

The eligibility criteria means 80% of the obese population on Medicare could get coverage for GLP-1s, despite the limits, said Chris Schott, an analyst at JPMorgan.

“Today’s deal will open up meaningful access to obesity medications,” Schott said in a note about Eli Lilly on Thursday.

Although there is no clear evidence that private insurers will expand coverage in the wake of government plans, “it is visually difficult for them to continue to restrict coverage when Medicare and Medicaid cover it,” Lakdawala added.

“This will put some pressure on expanding commercial coverage for these drugs as well,” Lakdawala said.

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

Lakdawala said the direct-to-consumer offerings under the deal could be beneficial to people who are underinsured, uninsured or may not have coverage for obesity medications. However, it is unclear how many patients the drugs will reach due to the offers.

Both Eli Lilly and Novo Nordisk have offered lower-cost options for their medications for people who pay cash and buy medications directly through their websites. But the deals with Trump will give those patients bigger discounts.

On TrumpRx, the average monthly cost for Wegovy, Zepbound and other injectable GLP-1 products will start at $350 and drop to $250 over the next two years, according to senior Trump administration officials. Both Eli Lilly and Novo Nordisk offered some GLP-1 products on their direct-to-consumer platforms for as much as $450 to $500 per month.

Initial doses of the obesity pill from Eli Lilly and Novo Nordisk — expected to hit the market next year — will be $149 a month on TrumpRx, Medicare and Medicaid.

Eli Lilly said Thursday it will cut prices by $50 on its direct-to-consumer platform, LillyDirect, which already offers Zepbound and other drugs at a discount to patients who pay with cash. The Zepbound Multi-Dose Pen will be available for $299 per month at the lowest dose, with additional doses going for $449 per month.

Regarding Medicaid, Cornell’s Fabrizio said states would likely want to start covering obesity drugs at a lower price, “but the question is how are they going to pay for it?”

About a dozen state Medicaid programs cover obesity drugs, according to 2024 estimates from KFF, a health policy research organization. While GLP-1 programs provide significant health benefits to Medicaid beneficiaries, state programs already face constrained budgets and administrative requirements.

Fabrizio added that raising taxes to cover drugs “could be a thorny problem.”

However, offering lower rates to Medicaid programs could lead to a “significant increase in coverage” in that channel, where Zepbound has only very limited capacity, JPMorgan’s Schott said.