Weight Loss Drugs and Medicare
If you are a Medicare agent, there is no doubt you have been asked about weight loss drugs and Medicare coverage. There is some big news for Medicare beneficiaries: starting in 2026, weight loss medications will be covered through a Medicare Part D pilot program. Thanks to recent deals between the Trump administration and drug makers Eli Lilly and Novo Nordisk, eligible clients can access these medications for just $50 per month, down from $1,000 or more.
Who Qualifies
Not everyone will be eligible. The program targets about 10% of Medicare enrollees with severe obesity or high-risk conditions:
- Severely obese (BMI > 35)
- Overweight (BMI > 27) with prediabetes or cardiovascular disease
- Obese with advanced kidney disease, heart failure, or uncontrolled hypertension
Medicare will cover about $245 per month, making the program affordable and accessible.
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How We Got Here
Initially, in April 2025, CMS decided not to cover anti-obesity medications due to high costs. Estimates suggested a potential $25–35 billion increase in spending over the next decade.
Everything changed in November 2025 when the Trump administration negotiated directly with manufacturers as part of the “Most Favored Nation” initiative. The result: a dramatic price drop that made coverage feasible without straining the Medicare budget.
TrumpRx: Option for Everyone
Even those who don’t qualify for Medicare coverage will have access to lower-cost medications starting January 2026 through TrumpRx.gov.
- Starting price: between $350 and $245/month
- Oral GLP-1 options expected pending FDA approval
- Available to anyone, regardless of insurance
What Medicare Covers Now
Before 2026, Medicare Part B covers obesity screenings and behavioral therapy, while Part D may cover GLP-1 drugs only if prescribed for diabetes or other approved conditions. Weight loss drugs are not otherwise covered.
Why This Matters for Agents
This is a game-changing opportunity for clients managing obesity or related health conditions. Agents can:
- Check Part D formularies for covered weight loss medications
- Compare plans for eligible clients
- Track policy updates in real time
The new coverage replaces compounded semaglutide options, giving clients access to brand-name medications at lower costs.
Agents who want to stay updated on events and information, click here
Two Pricing Tracks
- Trump Deal (2026): $245/month to Medicare, $50 copay for eligible beneficiaries
- IRA Negotiations, put in place by the Biden administration, (2027): Could bring additional savings for Ozempic and Wegovy
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What seemed improbable months ago is now reality. By staying informed and guiding clients through their coverage options, agents provide real value during the 2026 enrollment season and beyond.
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