At a White House event Thursday, President Trump announced deals with drugmakers Novo Nordisk and Eli Lilly to offer their popular GLP-1 obesity and diabetes drugs at lower prices for some Americans, namely some on Medicare and Medicaid plans. But questions linger about the significance of the deal.
According to the announcement, Medicare and state Medicaid programs will be able to purchase a month’s supply of Ozempic, Wegovy, Mounjaro, and Zepbound at $245 each for eligible patients. Eligible people on Medicare will have a $50 co-pay.
The negotiated price is a significant cut from the drugs’ list prices: The list price for Ozempic is $997, Wegovy is $1,350, Mounjaro is $1,080, and Zepbound is $1,086. But, of course, purchasers rarely pay drug list prices. It’s unclear how much Medicare and Medicaid would have paid for the drugs without this deal and what the savings will be.
It’s also unclear how many people in these federal programs will gain access to the new drugs and their negotiated prices. Federal programs currently are prohibited from covering any drugs intended for “weight loss.” The Biden administration proposed reinterpreting a federal rule to allow coverage of drugs specifically for the treatment of obesity. That change would have allowed 3.4 million people on Medicare and about 4 million on Medicaid to gain access to the drugs. But the Trump administration rejected the change.
The administration told reporters that the new drug pricing would be available to patients on Medicare and Medicaid who met specific conditions. The drugs at their new prices will be available to the following: those with a body mass index (BMI) over 27 who have also been diagnosed as pre-diabetic or have had a stroke, myocardial infarction, or peripheral artery disease; those with a BMI over 30 who also have stage-three kidney disease or other qualifying comorbidities; and those with a BMI over 35.