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.
Here are the key facts you need right now:
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
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.
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:
The coverage will be part of a pilot program designed to cover a majority of beneficiaries under Medicare Part D prescription drug plans.
Until the pilot program launches in 2026, here's what Medicare currently covers:
Related: 2026 Part D Updates & Carrier Highlights
Even if your clients don't qualify for Medicare coverage, they'll have a new lower-cost option starting January 2026.
TrumpRx.gov details:
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.
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:
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.
It's important to understand there are now TWO different price reduction efforts happening:
1. The Trump Deal (Effective 2026):
2. IRA Price Negotiations (Effective 2027):
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:
Read more: Your IntegrityCONNECT Getting Started Guide Is Here – Download It Now!
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.