Lilly and the US government agree on tirzepatide pricing, including a $50 Medicare copay

Eli Lilly said on November 6, 2025 that it reached an agreement with the U.S. government to lower what Americans pay for its obesity medicines, including a $50 monthly Medicare copay for Zepbound (tirzepatide) in a multi-dose pen and for orforglipron, its investigational obesity pill, "starting as early as April 1, 2026" and provided both win FDA approval ^[1][4]. The White House announced parallel deals with Lilly and Novo Nordisk the same day as part of its "most-favored-nation" drug pricing push ^[2].

What the Lilly deal covers

Under the agreement, Medicare and state Medicaid programs will pay $245 per month for Ozempic, Wegovy, Mounjaro and Zepbound, which the White House says is less than half the prices proposed under the Biden administration ^[2][3]. The administration says these lower prices will let Medicare cover Wegovy and Zepbound for people with obesity and related conditions for the first time, with beneficiaries paying a $50 monthly copay ^[2]. A senior administration official said the $50 copay applies to all approved uses of injectable and oral GLP-1 drugs, including diabetes and obesity ^[5]. States must opt in for Medicaid pricing, so some may not ^[5].

For people paying cash, Lilly said the Zepbound multi-dose pen will be sold through LillyDirect's self-pay pharmacy at $299 for the lowest dose and up to $449 for higher doses — a $50 cut from current direct-to-patient prices — with refills capped at $449 ^[1]. Lilly said the pricing is "similar to what is available in Europe" ^[1]. Orforglipron, if approved, would start at $149 for the lowest dose and run up to $399 ^[1]. The multi-dose pen is not yet FDA approved; Zepbound is currently approved as single-dose pens and vials in 2.5 mg through 15 mg strengths ^[4].

Lilly also said Mounjaro (tirzepatide for type 2 diabetes), Trulicity (dulaglutide) and Emgality (galcanezumab-gnlm) will be added to LillyDirect for self-pay patients at 50% to 60% off current list prices ^[1]. The White House put specific numbers on two of those: Emgality at $299 per pen and Trulicity at $389 per month through TrumpRx ^[2].

Two things Lilly got in return: three years of tariff relief and an assurance it "will not be subject to future pricing mandates" ^[1]. And one important limit: "The scope of the agreement does not include pricing obligations in the commercial channel" ^[1] — meaning employer and marketplace plans are not part of the deal.

Numbers that don't fully line up

The sources give somewhat different figures for the government's own discount website. The White House fact sheet says Zepbound and orforglipron will fall from $1,086 per month to "an average of $346" on TrumpRx ^[2]. CNBC reported that administration officials described starting doses of existing injections like Zepbound and Wegovy at $350 per month on TrumpRx, "trending down" to $245 over two years ^[5]. The White House also lists a $150 initial monthly price for future oral GLP-1s ^[2], while Lilly and CNBC cite $149 for orforglipron's starting dose ^[1][5]. TrumpRx's launch date is described as January 2026 by CNBC ^[5] and simply "2026" elsewhere ^[3].

Why it matters for patients

For Medicare beneficiaries, this is the first time the program is slated to cover these drugs for obesity, and Medicare insures about 66 million people ^[5]. A $50 monthly copay would be a large change from list prices that Lilly and Novo have charged — roughly $1,000 to $1,350 a month before insurance ^[5].

But several conditions apply. The Medicare copay depends on FDA approval of the Zepbound multi-dose pen and of orforglipron ^[1]. The April 1, 2026 date is a "as early as" target, and CNBC reported Medicare coverage for obesity starting mid-2026 ^[5]. Medicaid access depends on each state opting in ^[5]. And people with commercial insurance are explicitly outside the agreement, so their copays and coverage rules are unaffected by it ^[1].

What happens next

Lilly said it applied for the Commissioner's National Priority Voucher for orforglipron, which could speed FDA review ^[1]; the FDA said on November 6 it had awarded priority review vouchers covering the pill ^[5]. TrumpRx is expected to launch in January 2026 ^[5], with Medicare pricing beginning as early as April 1, 2026 ^[1]. Exact eligibility rules for Medicare coverage were not detailed in these announcements.