Lilly and Novo Nordisk agree to most-favored-nation pricing on GLP-1 drugs

President Trump on Nov. 6, 2025, announced "most-favored-nation" pricing agreements with Eli Lilly and Novo Nordisk that cut what Medicare, Medicaid and cash-paying patients pay for GLP-1 drugs, and that open the door to Medicare coverage of obesity treatment for the first time ^[1][2].

Under the deals, Medicare and state Medicaid programs will buy Ozempic, Wegovy, Mounjaro and Zepbound at $245 a month for weight loss and diabetes, and Medicare beneficiaries will pay a $50 monthly copay ^[1][4]. The White House said those government prices are less than half what the Biden administration had proposed ^[1]. Medicaid participation is not automatic: the companies agreed to extend the $245 price across all non-starting doses to all 50 state programs, but states have to opt in, so some may not ^[2].

The cash prices

On TrumpRx, the administration's direct-to-consumer website, the White House said Ozempic and Wegovy will fall from list prices of $1,000 and $1,350 a month to $350, and Zepbound and orforglipron, if approved, will fall from $1,086 to an average of $346 ^[1]. A senior administration official told reporters that starting doses of Wegovy and Zepbound will be $350 a month on TrumpRx and will "trend down" to $245 over a two-year period ^[2].

The sources differ slightly on oral GLP-1 pricing. The White House fact sheet says the initial dose of pipeline oral GLP-1s, including the Wegovy pill if approved, will be $150 a month through TrumpRx ^[1]. CNBC reported an administration official put the starting dose at $149 a month for everyone getting them through Medicare, Medicaid or TrumpRx ^[2]. Separately, Lilly said it would cut prices by $50 on its own LillyDirect platform, putting the Zepbound multidose pen at $299 a month at the lowest dose, with higher doses priced up to $449, and its pill, once approved, starting at $149 ^[2].

The agreements also cover non-GLP-1 products: Emgality at $299 per pen, Trulicity at $389 a month, and Novo insulins including NovoLog and Tresiba at $35 per month of supply ^[1]. Novo committed an additional $10 billion in U.S. manufacturing, and Lilly has announced at least $27 billion ^[1].

Who gets Medicare coverage

Coverage is not universal. CNBC reported Medicare will start covering obesity drugs for some patients in mid-2026 through a pilot under Part D, and that a senior official said about 10% of Medicare beneficiaries will be eligible for GLP-1s for obesity and cardiovascular and metabolic benefits ^[2]. Eligible patients fall into three groups: people who are overweight with a BMI above 27 plus prediabetes or established cardiovascular disease; people with a BMI above 30 plus uncontrolled hypertension, kidney disease or heart failure; and people with a BMI above 35 ^[2]. That is narrower than the FDA-approved population, which includes people with obesity or who are overweight with one related condition ^[2]. The official said the administration "worked very hard to strike a balance" between broad access and capturing patients who will benefit clinically ^[2].

Why it matters for patients

Cost has been the main barrier for many people, with list prices running roughly $1,000 to $1,350 a month before insurance ^[2]. For Medicare enrollees who qualify under the pilot, a $50 monthly copay would be a large change from no coverage for weight loss at all ^[2]. For people without insurance coverage, the TrumpRx and LillyDirect prices are another cash option, though the discounts apply to specific doses and the injectable cash price starts at $350, not $245 ^[1][2].

Several things remain unsettled. STAT reported that the precise timeline for the coverage expansion and the extent of who will gain access remain unclear ^[4]. It is also not yet known which states will opt into Medicaid pricing ^[2].

What happens next

CNBC reported TrumpRx.gov was set to launch in January 2026, and that Trump was expected to unveil negotiated prices for 15 drugs, including semaglutide, under the Inflation Reduction Act by Nov. 30 ^[2]. Tirzepatide likely will not be eligible for those negotiations until the end of the decade ^[2].

In January 2026, CMS announced a voluntary BALANCE model in which it negotiates directly with GLP-1 makers; the agency planned to launch it for participating state Medicaid programs on May 1 and for Medicare Part D plans on Jan. 1, 2027, with a bridge demonstration for Part D plans in July ^[5]. Novo said Wegovy pill prescriptions in the U.S. exceeded 265,000 in the week ending July 17, 2026 ^[6].