The White House announced that a new agreement has been reached with pharmaceutical manufacturers Eli Lilly and Novo Nordisk to increase access to GLP-1 antagonist medications – a newer class of drugs that have gained significant popularity for the treatment of obesity and diabetes.
Qualifying Medicare and Medicaid patients can receive certain GLP-1 drugs at a significant discount. Furthermore, individuals who purchase these drugs through TrumpRx, the White House's new direct-to-consumer will also receive discounts for cash purchases.
According to one White House official, 10% of Medicare beneficiaries will be eligible for GLP-1 medications.
This development has the potential to significantly expand access to and utilization of GLP-1 medications, as diabetes and obesity are common chronic health conditions in the U.S. population. Additionally, a significant amount of drug legislation across individual states is tied to CMS rules, creating several ripple effects across the country. It is very likely that CMS coverage, and policy changes could spill over into employer health plans and other commercial coverage.
And as obesity and diabetes are common comorbidities in workers’ comp, there are clinical considerations for how such drugs could impact pharmacy management in workers’ comp claims, especially as obesity and diabetes are common comorbidities found in workers’ comp claims.
Understanding the Discounts
According to the White House, the Medicare prices of Ozempic (semaglutide), Wegovy (semaglutide), Mounjaro (tirzepatide), and Zepbound (tirzepatide) will be $245. State Medicaid programs will have access to these prices, and Medicare patient co-pays for these drugs will be capped at $50 a month. The White House has stated that these new prices will allow Medicare to cover Wegovy and Zepbound for patients with obesity and related comorbidities.
When purchased through TrumpRx, the monthly price of Ozempic and Wegovy will be $350, while the monthly price of Zepbound and Orforglipron (a new GLP-1 medication still under review by the FDA) will be $346. In the event that the FDA later approves an oral formulation of Wegovy, or certain similar GLP-1 drugs in each company’s pipeline intended to be taken orally rather than as an injection, the initial dose of those drugs will be priced at $150 per month
The announced prices are expected to go into effect in January of 2026 for cash payers through TrumpRx, mid-2026 for Medicare patients, and on an ongoing basis for Medicaid enrollees, depending on when states register.
