Introduction to the Deal
President Donald Trump said Thursday his administration has reached an agreement with drugmakers Novo Nordisk and Eli Lilly to lower the cost of their blockbuster GLP-1 weight loss drugs, Wegovy and Zepbound, respectively.
Details of the Agreement
Under the deal, the monthly out-of-pocket cost of the drugs could range from $50 to $350, depending on the dosage and insurance coverage, a senior administration official said. Currently, Zepbound and Wegovy carry list prices above $1,000 a month, although both companies have introduced lower cost options for patients paying in cash and purchasing the drugs directly through their websites. To further expand access, Costco recently announced it would sell Wegovy and Ozempic for $499 for people who paid cash, while Walmart launched a similar arrangement with Lilly’s Zepbound.
Impact on Patients
People whose insurance covers the drugs usually pay much less than the list price. However, many insurers do not cover them. The agreements could make the popular treatments more affordable for millions who have struggled to access them — although experts say it remains unclear who would immediately benefit, since some of the drugs are already covered for Medicare patients with certain medical conditions and the new costs remain high for many patients.
What You Need to Know About Semaglutide
Here’s what you need to know about semaglutide, the drug commonly marketed as Wegovy and Ozempic. It’s unclear whether people on Medicare who need the drugs for weight loss alone would benefit. Medicare is barred from covering drugs that treat weight loss alone.
Trump’s Announcement
During a White House briefing, Trump said Medicare and Medicaid “will finally cover the cost of the weight loss drugs for millions of patients suffering from obesity.” On TrumpRx — the government’s discount platform for buying prescription drugs with cash — the average monthly cost for Wegovy and Zepbound will start at $350 and drop to $250 within the next two years, according to senior administration officials.
Existing Coverage
Medicare and Medicaid cover GLP-1 drugs for diabetes and some other medical conditions. These drugs include Novo Nordisk’s Ozempic and Lilly’s Zepbound. The drugmakers have voluntarily agreed to reduce the prices the government pays for all GLP-1 drugs already approved for diabetes and other indications to $245 a month across all non-starting doses. People on Medicare will pay no more than a $50 copay. People on Medicaid typically do not pay a copay.
Implementation and Expectations
The administration expects the direct-to-consumer pricing to be available by the end of the year on the TrumpRx site and Medicare coverage to be available by the middle of next year. The deal is part of Trump’s “most favored nation” push, an effort by the president to lower prescription drug prices and bring them more in line with other developed nations. Trump revived the initiative through an executive order in May after unsuccessfully pursuing it during his first term.
Expert Insights
Stacie Dusetzina, a health policy professor at Vanderbilt University in Nashville, Tennessee, said she has questions about how the plan would work next year, since Medicare has already set premiums and copays for 2026. She added that it’s also unclear how many people would be able to access the drugs under the new deal. Medicare already covers Wegovy for patients with heart disease risk and Zepbound for sleep apnea, but not for weight loss alone. Ozempic is covered for diabetes.
Additional Developments
“The good news,” Dusetzina said, “is that people who want to use these medications and have the money can access them through direct-to-consumer avenues.” Meanwhile, the deal mentioned GLP-1 pills that will cost $149. No GLP-1 pills for weight loss have been approved, although Novo Nordisk and Lilly are studying these formulations. Lilly said it has applied for a “priority voucher,” which would expedite the approval of a weight loss pill. A senior official said the administration expects that priority voucher will be approved Thursday.
Other Pricing Agreements
The administration has also reached similar pricing agreements with Pfizer and AstraZeneca to reduce costs for certain prescription drugs covered under Medicaid. The Biden administration previously proposed expanding Medicare and Medicaid coverage for GLP-1 drugs, but the Trump administration later rejected that plan.
Conclusion
In conclusion, the agreement between the Trump administration and drugmakers Novo Nordisk and Eli Lilly to lower the cost of GLP-1 weight loss drugs is a significant step towards making these treatments more affordable for millions of Americans. However, experts have raised questions about the scope and impact of the deal, particularly for those on Medicare who need the drugs for weight loss alone. As the details of the agreement continue to unfold, it remains to be seen how this will affect access to these life-changing medications.
FAQs
- Q: What is the new monthly out-of-pocket cost for GLP-1 weight loss drugs under the deal?
A: The monthly out-of-pocket cost could range from $50 to $350, depending on the dosage and insurance coverage. - Q: Are GLP-1 pills for weight loss approved?
A: No, GLP-1 pills for weight loss have not been approved, although Novo Nordisk and Lilly are studying these formulations. - Q: Will Medicare cover the cost of weight loss drugs for all patients?
A: It’s unclear whether people on Medicare who need the drugs for weight loss alone would benefit, as Medicare is barred from covering drugs that treat weight loss alone. - Q: How does this deal fit into Trump’s broader efforts to lower prescription drug prices?
A: The deal is part of Trump’s “most favored nation” push, an effort to lower prescription drug prices and bring them more in line with other developed nations. - Q: What other drugmakers have reached pricing agreements with the administration?
A: The administration has also reached similar pricing agreements with Pfizer and AstraZeneca to reduce costs for certain prescription drugs covered under Medicaid.
