11/07/2025
Summary of All the Announcements Regarding Obesity Medication Pricing
Exciting news in the world of obesity medicine yesterday. This is a step in the right direction to improve accessibility for patients. Still trying to process and understand all the details, but here is my summary of the major announcements.
The White House announced agreements with Eli Lilly and Novo Nordisk that will fundamentally change how patients access and afford GLP-1 medications.
Four Pathways for Patient Access:
1.TrumpRx.gov (Launching Jan 2026) This will be a government-run, direct-to-consumer cash-pay website.
- Injectables (Wegovy/Zepbound): Starting at ~$350/month, trending down to $245/month over two years.
- Oral GLP-1s (once approved): Starting doses will be priced around $150/month.
2. Medicare Coverage (Starting Mid-2026) For the first time, Medicare will cover these drugs for obesity through a CMS pilot program. This is an amazing milestone that we've all been waiting for.
- Patient Cost: A flat $50/month co-pay.
- Program Cost: Medicare will pay a rate of $245/month.
- Who Is Eligible? The pilot will target higher-risk beneficiaries, initially about 10% of the Medicare population. The criteria will be narrower than the FDA label, focusing on patients with:
- BMI >27 with prediabetes or established cardiovascular disease.
- BMI >30 with uncontrolled hypertension, kidney disease, or heart failure.
- BMI >35 (severe obesity).
3. Medicaid Coverage
- States will have the option to get the same low price of $245/month for GLP-1s for all covered uses.
4. LillyDirect (New Prices Available Very Soon)
- As a separate cash-pay option, Lilly has lowered its price for Zepbound to $299/month for the lowest dose (up to $449/month for higher doses). This is an immediate option for those without coverage.
- Also, Zepbound will be available in a new multi-dose pen so perhaps this will replace the vials and make it easier for patients to administer. (Awaiting FDA approval)
Pipeline & Regulatory Updates:
Fast-Tracking Oral GLP-1s: The FDA has granted priority review vouchers to speed up the review process for oral Wegovy and Lilly's orforglipron, shortening approval timelines.
This is a big step in the right direction for patients. I am optimistic about the public health impact. Curious to see how this will impact commercial insurance plan formularies. I hope this reduces their net prices to make it more feasible for coverage.
- Joe Zucchi, PA-C
