The White House announced agreements with Eli Lilly and Novo Nordisk to lower prices and expand access to GLP-1 medications (e.g., Wegovy®/semaglutide; Zepbound®/tirzepatide). The plan includes a federal TrumpRx portal, price caps for government programs, and signals of priority FDA review for oral GLP-1s in 2026. Independent reporting the day of the announcement confirms the framework and timelines.
Big picture: prices are slated to fall from list prices $1,000+/mo to **$149–$350/mo** depending on program and dose; Medicare copays have been described at ~$50/month once implemented; and state Medicaid programs will be able to opt into reduced pricing. Exact operational details will be finalized through CMS and state updates.
If you’re on
Medicare
- What’s new: The administration says Medicare will cover anti-obesity GLP-1s under the new deal, with patient copays around $50/month after implementation (targeted mid-2026). This represents a shift from the longstanding Part D exclusion on drugs “for weight loss.” Expect eligibility criteria (BMI + obesity-related conditions) in CMS guidance closer to rollout.
- Caveat: This reverses prior 2025 indications that Medicare would not expand coverage; today’s announcement supersedes those earlier positions but final rules are pending. Watch for formal CMS policy and plan formularies.
What to do now:
Save documentation of BMI and comorbidities (e.g., hypertension, sleep apnea, prediabetes).
Plan for mid-2026 enrollment window changes and Part D formulary updates.
If you’re on Medicaid
- What’s new: States will have the option to access reduced GLP-1 pricing (~$245/month reference) and expand coverage for obesity. Coverage will still be state-by-state with prior-authorization criteria.
- Context: As of 2024–2025, only a minority of states covered GLP-1s for obesity, often with tight restrictions. The new pricing pathway could broaden access—but timelines and criteria will vary by state.
What to do now:
Watch your state’s Medicaid Bulletin and Preferred Drug List (PDL) through 2026–2027.
Expect BMI thresholds, comorbidity requirements, and step-therapy rules.
If you have Commercial Insurance
(employer plan or Marketplace)- What’s likely: Commercial plans write their own formularies. Many limit or exclude GLP-1s for obesity today. Analysts and reporters expect private plans to move as government prices fall and coverage expands—but not all at once. Anticipate ongoing prior auth, step therapy, and BMI/comorbidity requirements, with changes rolling out unevenly in 2026–2027.
What to do now:
- Check your plan’s formulary and PA criteria before starting.
- Ask HR/benefits when 2026–2027 plan updates will be finalized.
If you’re Cash-Pay
(no coverage or excluded benefit) You now have legitimate, manufacturer-linked cash options:- LillyDirect (Zepbound®) — self-pay retail program with published monthly pricing and a new Walmart pick-up option (vials). Recent pricing communications and coverage note ~$299–$449/month depending on dose/form; some reports cite $349–$499 for vials. Verify the current offer at time of fill.
- NovoCare® Pharmacy (Wegovy®) — direct ship $499/month cash price across doses for eligible patients paying out of pocket.
- TrumpRx portal — a price-finding portal expected to route patients to the lowest direct prices once live; announcements reference a glide path toward ~$245/month average, and ~$149/month starter pricing for oral GLP-1s if/when approved. Details will clarify with launch.
Cash-pay sanity check:
Always use FDA-approved product from licensed programs (manufacturer programs or standard pharmacies). Be wary of compounded versions not meeting FDA standards. These new prices will definitely cost-compete with compounded versions. So many consumers may be switching back to branded medication.
Timelines, approvals & what’s still unsettled
- Timing: Multiple sources cite mid-2026 for Medicare implementation; Medicaid is state-dependent; commercial changes will likely phase in 2026–2027.
- Oral GLP-1s: FDA priority review has been signaled for 2026; until an oral product is approved for obesity, pricing figures are projections.
- Rules: Clinical eligibility (BMI, comorbidities, step therapy) will come via CMS/state and plan guidance; don’t treat headlines as coverage guarantees.
Should you start now—just because you can?
Short answer: Maybe—but not without a plan.GLP-1s are powerful metabolic tools, not magic. Success depends on medical selection and monitoring, protein-forward nutrition, progressive resistance training, sleep/stress, and a maintenance strategy.
Good candidates often include:
- Patients with obesity plus weight-related conditions (hypertension, prediabetes/diabetes, OSA, dyslipidemia).
- Peri-/post-menopausal women with metabolic risk—after hormone assessment.
Push pause & get evaluated first if:
- You’re hoping for a quick fix without lifestyle change.
- You have unmanaged thyroid, menopause, GI, or gallbladder/pancreatic issues.
- You’re unclear on interactions with current meds.
Professional take: Start with labs + risk review, then if appropriate, use slow titration, GI side-effect prevention, and a lean-mass protection plan (adequate protein + lifting). Plan ahead for coverage changes and off-ramp/maintenance.
Medicare • Get Ready for 2026
Let’s pre-qualify your eligibility (BMI/comorbidities) and build the lifestyle/strength plan that makes medication work and last. ➡️ Book a Medicare Readiness ConsultMedicaid • Check Your State Pathway
Coverage will vary. We’ll decode your state’s rules, handle prior-auth, and design your nutrition + training + hormone plan. ➡️ Request a Medicaid Coverage CheckCommercial Insurance • Don’t Assume
We’ll verify formulary, prior-auth, and total costs before you start—and protect results with a structured plan. ➡️ Start a Coverage & Eligibility ReviewCash-Pay • Safe, Legit, Strategic
We’ll compare LillyDirect vs NovoCare® vs evolving TrumpRx options and build a full program around the medication. ➡️ Ask About Cash-Pay OptionsAccess is improving and prices are coming down. For some, this is exactly the moment you’ve been waiting for. For others, starting with hormones, nutrition, and training may be the smarter first step. Either way, being followed by an expert is more important than ever.
