On Thursday, November 6, 2025 the President and several top advisors announced a deal with Eli Lilly and Novo Nordisk to nominally decrease the prices of their GLP-1 products. The deal also lets Medicare cover those drugs for weight-loss purposes. Details on the nuts and bolts of the deal are scarce. But, as with any big policy move, industry impacts could be profound.
Buckle up and brace for whiplash. Here’s a crash course in the topsy-turvy history of the government’s approach to these drugs.
The first GLP-1 was approved by the Food and Drug Administration in 2005 (Cleveland Clinic), but they didn’t really enter the public consciousness until recent years. Since approval, the drugs have been used in treating a wide variety of conditions – things like diabetes, obesity, sleep apnea, heart conditions, and well, a whole laundry list of others. That promise has led to both increasing demand and utility for the drugs, leaving both public and private insurers with a burning question: Will we cover GLP-1s, and how?
We’ll stay out of the weeds on private insurers (for now), but suffice to say that across all lines, if insurers are covering the drugs, it’s only to treat those with diabetes or other indicated chronic conditions. Few and far between are the plans that will cover them for weight loss, as insurers argue that there isn’t enough long-term data to tell whether they provide meaningful improvement.
For public insurers (think Medicaid and Medicare), the Biden administration first proposed that Medicare and Medicaid could cover GLP-1s for weight loss purposes in its proposed rule for CY2026. That proposal was issued on November 26, 2024 – just before the second Trump term began.
In January 2025, the Trump administration had taken office. And in April, it released the final rule for CY2026. Inside, it refused to cover GLP-1s for weight-loss purposes, stating it would cost the government far too much money.
One more policy angle to consider: The Inflation Reduction Act of 2022 allowed CMS and Medicare to directly negotiate drug prices for the first time. CMS has selected GLP-1s, including Ozempic, Rybelsus, and Wegovy, for negotiation. The results of those negotiations are not yet public, but any negotiated price would go into effect in 2027.
At the time of the original announcement, most of this was still an if. It isn't anymore. TrumpRx, the administration's direct-to-consumer prescription marketplace, launched February 6, 2026. Here's where pricing landed.
The original deal was easy to read as "GLP-1s are now cheaper for all Medicare beneficiaries." But now, GLP-1 access for that population travels in three separate lanes — a cash-pay platform, Part D's coverage for approved medical uses, and a standalone CMS pilot for weight-loss use — that all happened to be announced around the same time.
Medicare coverage for GLP-1s starts on July 1, 2026. The demonstration is called the Medicare GLP-1 BRIDGE program, but framing it as "Medicare now covers GLP-1s" isn't quite true. There are conditions for eligibility.
We covered the GLP-1 BRIDGE program and its BMI qualifications in depth, alongside more 2027 Part D changes, in a recent webinar. Check it out if you need more information about who is eligible, and what your role might be in these conversations.
It’s probably best to explore this by market.
Medicare enrollees get the lowest sticker price here, and as of July 1, 2026, it's live. But "best deal" comes with a big caveat: because the GLP-1 BRIDGE program runs outside the Part D benefit, that $50 copay doesn't count toward their Part D benefit. An eligible client will pay $600 per year, which brings them zero dollars closer to their out-of-pocket maximum.
A beneficiary who's also managing other chronic conditions and watching their drug spend closely might need some education on this. The low copay looks like a bargain in isolation, but can eat into budgets when looked at over the whole year.
Commercial enrollees – whether small or large – get a bit of a raw deal.
Group health plans (and the Pharmacy Benefit Managers who oversee formularies) were not participants in the negotiations. PBMs and large employers will need to negotiate their own rates for these drugs – should they choose to cover them for weight-loss purposes. And as we all know, lots of mouths get fed throughout the prescription drug market. So it’s unlikely, at least, in the short term, that customers using insurance will have access to these prices.
But what about customers who shop using TrumpRx when it becomes available?
While they’ll have access to the new lower prices, there’s an important caveat: Direct-to-consumer pharmaceutical sales rarely, if ever, count toward a consumer’s insurance accumulators.
Put another way, a consumer choosing to purchase these drugs directly via TrumpRx will pay, on average, $4,200 a year ($350 x 12 months). That’s $4,200 that won’t count toward deductibles or out-of-pocket maximums. Bluntly, that figure would challenge many consumers’ finances and leave them further exposed to the costs of other medical care.
Individual enrollees will find themselves in much the same boat as their commercial counterparts. There’s no guarantee the drugs will end up on their plans’ formularies, or at what price. Purchasing direct from TrumpRx would cause the same financial exposure that commercial enrollees would see, too.
The deal delivered on a promise to lower prescription drug prices — at least for some Americans. What was unclear was whether it would ripple outward.
And we still don't have much evidence to say it has. Commercial formularies haven't moved much, and the cash-pay price, while improved, can still be a burden on some. The bigger open question is still ahead of us: Will carrier participation in BALANCE improve if GLP-1 BRIDGE performs well?
If you're fielding questions on any of this before AEP, our Late Enrollment Penalty calculator and the 2027 Part D updates cover the adjacent pieces your clients will ask about in the same conversation.