Updated April 17, 2025. Updated again November 12, 2025.
Medicare will finally cover weight loss drugs starting in 2026.
On November 6, 2025, President Trump announced deals with Eli Lilly and Novo Nordisk that slash prices and bring coverage to eligible beneficiaries for just a $50 copay – down from over $1,000 per month out-of-pocket.
Here's what agents need to know about this game-changing development and what it means for your clients.
The Deal in a Nutshell
Here are the key facts you need right now:
- Coverage starts: 2026 through a Medicare Part D pilot program
- Who qualifies: Approximately 10% of Medicare beneficiaries with severe obesity (BMI > 35) or those who are overweight with prediabetes, cardiovascular disease, or other qualifying conditions
- Beneficiary cost: $50 copay per month
- What Medicare pays: $245 per month (down from $1,000-$1,350)
- Bonus option: TrumpRx.gov launches January 2026 for anyone to buy GLP-1s at $350/month (trending to $245), regardless of insurance status
Read more details in The White House fact sheet: Fact Sheet: President Donald J. Trump Announces Major Developments in Bringing Most-Favored-Nation Pricing to American Patients
From "No" to "Yes": How We Got Here
Let's rewind. On April 4, 2025, CMS released its final rule for Contract Year 2026 and officially decided NOT to include anti-obesity medication coverage.
That decision killed the Biden administration's November 2024 proposal and seemed to end the conversation.
Cost was the major factor. The proposed coverage was estimated to cost Medicare about $25 billion over a decade, with the Congressional Budget Office projecting an additional $35 billion between 2026 and 2034.
But then everything changed.
Seven months later, as part of President Trump's "Most Favored Nation" drug pricing initiative, the administration negotiated directly with pharmaceutical manufacturers. The result? Dramatically lower prices that made coverage financially viable.
The Trump administration's deal slashes what Medicare pays from around $1,000-$1,350 per month to just $245, or about one-ninth of the current list price (White House Fact Sheet). That massive price reduction is what makes the new coverage possible without breaking the budget.
Who Qualifies for the New Coverage
Not every Medicare beneficiary will be eligible – the pilot program targets approximately 10% of enrollees. Your clients will qualify if they meet one of these criteria:
- Severely obese with a body mass index (BMI) greater than 35
- Overweight (BMI > 27) with prediabetes or established cardiovascular disease
- Obese with advanced kidney disease, heart failure, or uncontrolled hypertension
The coverage will be part of a pilot program designed to cover a majority of beneficiaries under Medicare Part D prescription drug plans.
What Medicare Currently Covers (Before the 2026 Changes)
Until the pilot program launches in 2026, here's what Medicare currently covers:
- Medicare Part B covers obesity screenings and behavioral therapy for beneficiaries with a BMI of 30 or higher.
- Medicare Part D may cover GLP-1 medications like Ozempic, but only if prescribed for diabetes or another approved condition.
- Medicare does NOT cover weight loss drugs unless prescribed for another approved condition.
Related: 2026 Part D Updates & Carrier Highlights
The TrumpRx Option
Even if your clients don't qualify for Medicare coverage, they'll have a new lower-cost option starting January 2026.
TrumpRx.gov details:
- Government-run direct-to-consumer website launching January 2026
- Starting price: $350/month for injectable GLP-1s
- Price will trend down to $245/month over two years
- New oral GLP-1 pills (pending FDA approval): $149/month for starting dose
- Available to anyone paying out-of-pocket, regardless of insurance status
Novo Nordisk and Eli Lilly are both developing oral versions of their weight loss medications that received priority FDA review vouchers on November 6 (CNN). If approved, these pills could be game-changers for patients who don't want injections.
The Compound Medication Cutoff
Remember the compounded versions of semaglutide that were available during the shortage? That window closed earlier this year.
Since the FDA declared the Ozempic and Wegovy shortage resolved on February 21, 2025, pharmacies had to stop making compounded versions:
- State-licensed pharmacies stopped by April 22, 2025
- Outsourcing facilities stopped by May 22, 2025
This leaves only the brand-name options available, but with the new pricing through Medicare and TrumpRx, access is actually better than it was with compounded versions for many patients.
Trump Deal vs IRA Negotiations
It's important to understand there are now TWO different price reduction efforts happening:
1. The Trump Deal (Effective 2026):
- Part of "Most Favored Nation" pricing initiative
- $245/month price to Medicare for obesity coverage
- $50 copay for eligible beneficiaries
- Separate from Inflation Reduction Act
2. IRA Price Negotiations (Effective 2027):
- Ozempic and Wegovy selected in January 2025 for second round of Medicare drug price negotiations
- Will affect prices starting 2027
- Could bring additional savings beyond the Trump deal
According to a senior administration official, the Trump deal is NOT part of the IRA negotiation process (Axios)—these are separate tracks that could both bring savings.
IntegrityCONNECT
When Medicare starts covering weight loss drugs, IntegrityCONNECT makes it easy to compare costs and coverage options.
If you’re not already using it, now’s the time!
It’s free for contracted agents and helps you:
- Check Part D formularies for covered medications
- Compare plans for clients asking about weight loss drug coverage
- Track updates on policy changes in real time
Read more: Your IntegrityCONNECT Getting Started Guide Is Here – Download It Now!
Conclusion
What seemed impossible in April became reality in November.
The Trump administration's deals with Eli Lilly and Novo Nordisk represent a landmark shift in Medicare coverage policy and drug pricing.
By staying informed about these developments and ready to explain the options clearly, you can provide tremendous value during the 2026 enrollment season and beyond.
