Medicare to Cover Obesity Drugs as Low as $149 under White House Deals
Significant changes are coming to the availability and pricing of obesity medications for Medicare enrollees. The Trump administration has announced deals that will allow certain blockbuster obesity drugs to be accessible for as low as $149 per month.
Details of the New Medicare Obesity Drug Deals
Under the agreements reached with Eli Lilly and Novo Nordisk, prices for obesity drugs will significantly drop. Currently, these medications can cost between $1,000 and $1,350. With the new arrangement, consumers may see drugs priced at an average of $350 per month, with a commitment to reduce this to approximately $250 over the following two years.
Injectable GLP-1 medications will be at the forefront of this initiative. If approved by the FDA, oral GLP-1 tablets will start at $149 for the lowest dose. The implementation of these prices is scheduled for mid-2026, coinciding with the launch of TrumpRx, a direct-to-consumer website aimed at facilitating the acquisition of these medications.
Eligibility for Medicare Enrollees
Medicare enrollees with specific medical conditions will benefit most from these changes. Eligible conditions include:
- Obesity and diabetes
- Prediabetes
- Previous strokes or other cardiovascular diseases
- Uncontrolled high blood pressure with severe obesity
It is estimated that about 10% of Medicare enrollees will qualify for expanded access to obesity medications under these new terms. Additionally, a $50 copay will apply to certain GLP-1 medications approved for both obesity and diabetes.
Impact on Medicaid and Other Programs
This announcement also impacts state Medicaid programs. Eli Lilly and Novo Nordisk have agreed to offer their medications at reduced prices, although negotiations with individual states will dictate timing.
Current State of Coverage
As of August 2024, a KFF survey indicated that 13 states provided coverage for expensive weight-loss drugs. However, some states, such as North Carolina, have recently opted to withdraw funding for these medications.
Political Context and Future Implications
The drug price negotiations initiated by the Trump administration underscore a broader effort to lower pharmaceutical costs for consumers. By reinvigorating initiatives like the Most Favored Nation pricing, officials aim to create a system where drug prices are more aligned with those in other developed nations.
As these changes unfold, the administration emphasizes their commitment to maintaining cost neutrality. This comes in stark contrast to previous proposals by the Biden administration, which aimed at expanding coverage but lacked accompanying price reductions. The upcoming years will be crucial for both policy implementation and monitoring its effects on the Medicare program and its enrollees.
