More than 20 drugmakers have now signed US drug-pricing deals, including Novo Nordisk and Eli Lilly

More than 20 drugmakers have now announced U.S. drug-pricing agreements with the Trump administration, after a second wave in late August 2026 added nine companies, most of them smaller firms offering medicines to state Medicaid programs at most-favored-nation prices ^[1]. The deals also include sales through TrumpRx.gov, the government's direct-to-patient site, and commitments to invest in U.S. manufacturing ^[1].

The first wave covered 17 major drugmakers and began last year. Those agreements combined most-favored-nation pricing — a term for matching the lower prices paid in other developed countries — with sales through TrumpRx.gov and U.S. investment pledges in exchange for tariff relief ^[1]. Small and mid-size companies had been slower to sign on ^[1].

For GLP-1 medicines, the terms disclosed so far are specific. Novo Nordisk agreed in November to cut prices for its semaglutide products, Wegovy and Ozempic, through Medicare, Medicaid and a direct-to-patient cash channel ^[1]. Under the deal, the monthly price of Ozempic falls from $1,000 to $350 and Wegovy's from $1,350 to $350 when purchased through TrumpRx ^[1]. Novo Nordisk also agreed to provide NovoLog and Tresiba insulin at $35 per month through TrumpRx ^[1].

Eli Lilly, in the same month, agreed to offer Medicare beneficiaries its obesity medicines Zepbound (tirzepatide) and orforglipron, sold as Foundayo, at no more than $50 per month, with additional discounts for self-pay patients through LillyDirect ^[1]. The Zepbound multidose pen is listed at $299 per month at the lowest dose, with other doses priced up to $449, while Foundayo starts at $149 per month at its lowest dose through LillyDirect ^[1]. Lilly also listed migraine treatment Emgality at $299 per pen and diabetes medicine Trulicity at $389 per month through TrumpRx ^[1].

Other agreements vary widely. Pfizer's deal includes discounts of up to 85% through TrumpRx, with average savings of 50% on most primary care treatments and some brands ^[1]. AstraZeneca agreed to discounts of up to 80%, Sanofi to average savings of about 70%, and GSK to up to 66% ^[1]. Amgen listed cholesterol drug Repatha at $239 a month ^[1]. Regeneron cut the cash price of cholesterol drug Praluent to $225 from $537 ^[1]. Bristol Myers Squibb agreed to provide blood thinner Eliquis to Medicaid for free and to donate more than seven tons of its active ingredient ^[1]. Australia's CSL committed $1.5 billion to Illinois manufacturing, creating more than 1,100 jobs ^[1]. Johnson & Johnson's January agreement did not disclose terms, including which medicines are covered ^[1].

Spending pressure is the backdrop. A PwC analysis projects a 9% rise in medical cost trend in 2027, the fifth consecutive year of elevated health care inflation, and more than 85% of surveyed health plan actuaries said pharmacy costs are rising faster than overall medical costs ^[2]. GLP-1 prescribing keeps growing as the drugs are used for obesity, cardiovascular disease, chronic kidney disease, obstructive sleep apnea and MASH, and new oral formulations could widen adoption further ^[2].

Why it matters for patients

The prices in these agreements apply to specific channels — TrumpRx, LillyDirect and Medicaid — not to every prescription. The $350 monthly prices for Ozempic and Wegovy and the $50 monthly Medicare price for Zepbound and Foundayo are tied to those programs, and the announcements do not spell out how they interact with commercial insurance formularies, copays or deductibles. Terms of some deals were not disclosed, including Johnson & Johnson's, so which medicines are covered and what patients pay under them has not been reported ^[1]. Medicaid pricing is a central piece of the second wave, so people enrolled in those state programs are most directly affected ^[1].

What happens next

PwC projects the medical cost trend will rise 9% in 2027 and expects GLP-1 use to keep expanding ^[2]. Whether additional companies sign agreements, and whether the terms of the undisclosed deals are released, has not been announced ^[1].