Lilly and U.S. government agree to $50 Medicare copay for Zepbound and orforglipron

Eli Lilly and the U.S. government announced an agreement on Nov. 6, 2025 that caps Medicare copays at no more than $50 a month for Zepbound (tirzepatide) and for orforglipron, Lilly's experimental once-daily obesity pill, starting as early as April 1, 2026 ^[1][4]. Lilly said both products would need FDA approval for that pricing to apply ^[1][4].

Lilly said the arrangement covers nearly 40 million Americans with obesity on government insurance programs, and that states will be able to expand access to Zepbound and orforglipron through Medicaid ^[1][4].

The numbers

For people paying cash, Lilly said the Zepbound multi-dose pen would be available at the lowest dose for $299, with higher doses up to $449, which the company described as a $50 discount to current direct-to-patient prices. Refills through the LillyDirect digital health platform would cost no more than $449 ^[1][4]. Orforglipron, if approved, would start at $149 for the lowest dose and run up to $399 for additional doses ^[1][4].

The White House described the same products differently in its own fact sheet, saying the price of Zepbound and orforglipron would fall from $1,086 a month to an average of $346 when purchased through TrumpRx, a government purchasing site ^[2]. CNBC reported that starting doses of existing injections including Wegovy and Zepbound would be $350 a month on TrumpRx and would "trend down" to $245 over a two-year period, and that starting doses of upcoming obesity pills would be $149 a month for people getting them through Medicare, Medicaid or TrumpRx ^[5].

The agreement also adds Mounjaro (tirzepatide for type 2 diabetes), Emgality and Trulicity to LillyDirect for self-pay patients at 50% to 60% off current list prices ^[1][4]. The White House said Trulicity would be priced at $389 a month, a $598 discount, and Emgality at $299 per pen, a $443 discount ^[2].

Medicare and Medicaid would pay $245 for Ozempic and Wegovy (both semaglutide), Mounjaro and Zepbound, according to the White House and AJMC ^[2][3]. States would have to opt into the Medicaid prices, meaning some may not, CNBC reported ^[5].

Lilly said the agreement does not include pricing obligations in the commercial channel, so employer and individual market plans are not covered by these terms ^[1][4]. Lilly will receive three years of tariff relief and will not be subject to future pricing mandates ^[1][4].

Why it matters for patients

Medicare has not covered these drugs for weight loss, and the White House said the new prices will let Medicare cover Wegovy and Zepbound for patients with obesity and related conditions for the first time ^[2][5]. Medicare covers about 66 million people and is the main source of insurance for adults 65 and older ^[5].

The practical effect depends on how a patient gets coverage. Someone on Medicare with obesity could see a $50 monthly copay starting as early as April 2026 ^[1][4]. Someone with commercial insurance is not covered by this deal ^[1][4]. Someone in a state Medicaid program depends on whether that state opts in ^[5].

For people paying cash, the new LillyDirect prices apply only to the Zepbound multi-dose pen, which Lilly said needs FDA approval, and not to the single-dose pens or vials now sold ^[1][4]. Orforglipron is not approved; Lilly is running Phase 3 trials in type 2 diabetes and in weight management for adults with obesity or overweight with at least one weight-related condition ^[1][4]. Which specific obesity-related conditions will qualify someone for Medicare coverage has not been disclosed in these materials.

What happens next

TrumpRx is scheduled to launch in January 2026 ^[5]. The April 1, 2026 Medicare copay date is described by Lilly as the earliest possible start ^[1][4]. Lilly applied for a Commissioner's National Priority Voucher for orforglipron, and the FDA said on Nov. 6 that it awarded priority review vouchers meant to speed review ^[1][4][5]. CNBC reported Novo Nordisk's oral Wegovy could reach the market by the end of 2025 and orforglipron could launch in 2026 ^[5]. Lilly said it is investing more than $50 billion in U.S. manufacturing, while the White House put the figure for new U.S. manufacturing investments at least $27 billion ^[1][2].