November 6, 2025

Questions on the White House Weight Loss Drug Announcement

This afternoon the White House held a presser announcing new deals entered with Eli Lilly and Novo Nordisk to expand coverage and lower prices of anti-obesity medications Zepbound and Wegovy as well as other products in the companies’ portfolios.

While precise details of the arrangements remain undisclosed, you can find the White House fact sheet here.

New York Times coverage is here.

Here are some of our initial takeaways and impressions of the announcement as well as questions.

• Some patients stand to benefit from expanded access to weight loss medications if discounted prices are sustained and made widely available. But simultaneously, President Trump and the GOPs Big Ugly Bill is taking health coverage away from millions of Americans.
• While expanding Medicare and Medicaid coverage of anti-obesity medications for some indications is welcome, it is unclear whether Medicare plan coverage will be mandatory or optional. Expanded Medicare and Medicaid coverage is still likely to leave out some beneficiaries.

• Lower direct-to-consumer prices will likely benefit some, but the drugs will remain out of reach for many patients who cannot afford $150 and more out-of-pocket each month.

• Without the power of the Medicare drug price negotiation program, passed by congressional Democrats without a single Republican vote and signed into law by President Biden, today’s deal may not have been possible.
  • Semaglutide, the active ingredient in Wegovy, was selected for Medicare drug price negotiation under the law and its negotiated price that takes effect in 2027 is scheduled to be announced before the end of November.
• The potential to allow for Medicare and Medicaid to provide wider coverage of weight loss drugs also provided an incentive for the Trump Administration to dangle in front of drug companies to secure discounted prices. Competition from compounding pharmacies producing compounded versions of GLP-1s was already putting pressure on Lilly and Novo to offer products at deeper, more competitive discounts.

Questions:

• How many patients who did not previously have access to Wegovy and Zepbound through existing Medicare and Medicaid coverage will obtain access? The Biden Administration’s proposal that the Trump Administration rejected was projected to expand access to 3.4 million Medicare beneficiaries and around 4 million patients through Medicaid.

• • Reporting from the New York Times indicates that under the deals announced today, “Medicare and Medicaid will extend coverage to patients with obesity “at high metabolic or cardiovascular risk”: patients with a body mass index greater than 27 with prediabetes, or established cardiovascular disease, or have had a stroke; with a BMI over 30 and uncontrolled hypertension despite treatment, advanced kidney disease, or heart failure; or with BMI greater than 35.” The Times added that “Many of these types of patients, though, likely already meet current Medicare coverage conditions,” and “Those measures are likely to expand access but still will stop far short of covering all of the millions of people with obesity under those federal programs.”
• Medicare recently negotiated a price for semaglutide through the Medicare drug price negotiation program. A negotiated price for semaglutide would also be likely to pressure Eli Lilly to offer lower prices. The negotiated price for semaglutide, which will take effect in 2027, is required to be announced by the end of the month. How does the $245 price for Wegovy announced today compare the “Maximum Fair Price” (MFP) negotiated pursuant to the Inflation Reduction Act? How did negotiations around this deal intersect with MFP negotiations conducted by CMS?
• Medicaid already receives substantial discounts on drugs. How does the proposed $245 price for Medicaid compare to current Medicaid prices for GLP-1s?

• What price discounts were Novo and Lilly already planning or considering, in the face of pressure from compounding pharmacies providing compounded versions of GLP-1 drugs?

• What will the prices of subsequent doses of oral GLP-1 drugs be, if approved? The White House fact sheet indicates the $150 direct-to-consumer price will be available for the initial dose, but it does not indicate the prices for subsequent doses. New York Times reporting has also indicated that the $150 price is only available for the lowest doses of the pill.

• • Director Klomp indicated that “average prices” for DTC sales of Wegovy and Zepbound would start at $350 and trend down to $249 over 24 months. Why does the Trump Administration claim that these are “most favored nations” prices while prices for these drugs in the UK are still lower?

• Are commercial insurance plans excluded from the discounted price for GLP-1s or other drugs? While Director Klomp indicated that future “MFN” prices would be available to patients with commercial insurance, only TrumpRx, Medicare and Medicaid are mentioned on the White House fact sheet.

• • Is eligibility for access to discounted prices limited based on insurance status, income, or other factors?
  • Do purchases by insured patients through direct-to-consumer channels count towards deductibles and out-of-pocket maximums?