Medicare, GLP-1s, and TrumpRx: What You Need To Know
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If you have Medicare and have heard about Trump’s deal on Ozempic, Wegovy, Zepbound, and other GLP-1 drugs, you are not alone if you feel confused.
For years, federal law has kept Medicare from paying for most medications used only for weight loss, even when they are FDA approved for obesity treatment. That includes GLP-1 drugs like Wegovy and Zepbound when they are prescribed for weight management instead of diabetes. (Congressional Research Service) (National Council on Aging)
In November 2025, the Trump administration announced a new set of pricing deals with Novo Nordisk and Eli Lilly, plus a pair of Medicare “demonstration” projects that will let some plans cover GLP-1 obesity medications starting in 2026 for people who meet strict rules. (Obesity Action Coalition) (White House fact sheet)
This guide walks through what is actually happening, what it might mean for you or a family member, and what questions to ask next.
This article is for education only. It does not replace medical advice from your own doctor or coverage details from your own Medicare plan.
Why Medicare has not covered GLP-1 drugs for weight loss
A quick history lesson helps the rest make sense.
- Medicare law has a specific rule that says Part D drug plans cannot cover medications “used for anorexia, weight loss, or weight gain.” That is why Part D does not cover modern anti obesity medications when the main purpose is weight loss. (Congressional Research Service) (Congressional Budget Office)
- Medicare and Medicaid do cover GLP-1 drugs in other situations, such as type 2 diabetes or certain heart disease indications, because those uses are clearly allowed under current law. (ASPE / HHS issue brief)
- Medicare also covers some non drug obesity treatments, like intensive behavioral therapy and bariatric surgery, under Part B for people who qualify. (National Council on Aging)
Advocates and medical groups have pushed Congress for years to fix this with a law called the Treat and Reduce Obesity Act, but it has not passed yet. (Treat and Reduce Obesity Act overview)
So Medicare needed another path.
What TrumpRx is and how the new pricing deal works
TrumpRx is a national website the administration is building that will connect people directly to manufacturer programs from Novo Nordisk and Eli Lilly. It does not sell medications itself. Instead, it is a kind of “front door” that sends you to company run programs like NovoCare or LillyDirect or partner pharmacies. (Reuters) (Managed Healthcare Executive)
Under the agreements announced so far:
- For cash paying (self pay) adults, Ozempic and Wegovy will be available for about $349 to $350 a month across most doses, instead of list prices near or above $1,000. (Reuters) (People Magazine health coverage)
- Zepbound from Eli Lilly will start around $299 a month for the lowest dose, with higher doses costing more, when bought through TrumpRx or Lilly’s direct platform. (Benefits and Pensions Monitor)
- For government programs like Medicare and Medicaid, the manufacturers agreed to sell injectable GLP-1 drugs such as Ozempic, Wegovy, Mounjaro, and Zepbound at $245 per month for each drug, across all doses and indications. (White House fact sheet) (Academy of Managed Care Pharmacy brief)
- Future oral GLP-1 weight loss drugs, still under FDA review, are expected to have starting prices around $149 a month for both government programs and self pay users when they are approved. (The Well News) (PBS NewsHour)
These prices matter because they give Medicare a much lower “starting point” than older proposals that would have cost the program far more. (Obesity Medicine Association)
How Medicare plans will be allowed to cover GLP-1s for obesity
Since the law has not changed (yet), Medicare is planning to use two special demonstration projects to cover GLP-1 obesity medications for some people.
Both demonstrations were described by the Obesity Action Coalition after the announcement. (Obesity Action Coalition)
Section 402 Part D demonstration – starting April 2026
Section 402 is a part of federal law that lets Medicare “test” new payment ideas without rewriting the main statute. For GLP-1s, the plan looks like this:
- Starting April 2026, certain Medicare Advantage and stand-alone Part D plans can choose to join a demonstration that covers FDA approved obesity medications, including GLP-1s, for people who meet strict criteria.
- Medicare pays the plans a special rate based on the $245 per month drug price that was negotiated with the manufacturers.
- People on Medicare who qualify will pay about a $50 monthly copay for each GLP-1 obesity medication covered through the demo.
- Plans have to opt in. If your Medicare plan does not join, you may not get this coverage even if you meet the health criteria. (Obesity Action Coalition) (American Action Forum policy brief)
CMMI Medicare demonstration – starting January 2027
The second phase runs through the Center for Medicare and Medicaid Innovation (often shortened to CMMI).
- This CMMI demo is expected to start January 1, 2027 and extend the same basic coverage pattern of the 402 demo so Medicare can keep paying for obesity medications past the initial test period.
- It is designed to use the same $245 drug price and about $50 monthly copay for eligible beneficiaries, although exact details may shift as rules are written. (Obesity Action Coalition)
Medicaid and state options
The same $245 price will be available to Medicaid programs, and states can decide whether to join in. That means low income adults in some states may see Medicaid coverage for GLP-1 obesity medications at very low or no copays, while others may not. (Obesity Action Coalition) (Obesity Medication Access policy page)
Who will likely qualify under the Medicare demonstrations
The specific medical criteria for the demos are not final, but the Obesity Action Coalition has shared the draft coverage rules that were presented with the administration’s slides. (Obesity Action Coalition)
In plain language, the early proposal looks like this:
- BMI 27 or higher plus at least one serious health problem related to weight, such as prediabetes and established cardiovascular disease, peripheral artery disease, metabolic dysfunction associated steatohepatitis (MASH), or diabetes.
- BMI 30 or higher with additional issues like uncontrolled high blood pressure, moderate to severe chronic kidney disease, heart failure, sleep apnea, or MASH.
- BMI 35 or higher with obesity alone.
Early analysis suggests that these rules could apply to roughly 80% of patients who are likely to benefit from anti obesity medications, though the final share will depend on how plans implement the criteria. (Obesity Action Coalition) (Obesity Medicine Association)
To picture BMI in real life:
- A person who is 5′4″ and weighs about 175 pounds has a BMI near 30.
- A person who is 5′9″ and weighs about 240 pounds has a BMI near 35.
Your doctor can calculate your exact BMI and talk through whether these rules might apply to you.
What a typical Medicare user might pay
If everything moves forward as described, here is what costs might look like for many older adults.
If your Medicare plan joins the demonstration and you qualify
- You would pay about $50 per month per GLP-1 obesity medication until you reach your usual Part D out of pocket maximum for the year.
- Behind the scenes, Medicare and your plan would be paying the manufacturer $245 per month for that drug. (Obesity Action Coalition) (Academy of Managed Care Pharmacy brief)
If your plan does not join or you do not meet the criteria
You would not get the special $50 Medicare copay for obesity treatment. You might still have options:
- If you have diabetes or certain heart disease indications, your plan may already cover GLP-1 drugs for those reasons. That is separate from the obesity demonstrations. (Time Magazine health reporting)
- You may be able to use the cash pay TrumpRx prices, which are expected to be around $349 to $350 per month for many injectable GLP-1s, $299 for the lowest dose of Zepbound, and about $149 for future oral versions if they are approved. (Reuters) (The Well News)
These are still significant amounts of money, but far below current list prices and far below the amounts many Medicare users pay out of pocket today.
What if you already use a GLP-1 drug
Right now, Medicare covers GLP-1 drugs only when they are used for approved diabetes or heart disease indications, not for weight loss alone. (ASPE / HHS issue brief) (National Council on Aging)
If you already take a GLP-1:
- Your current coverage is unlikely to change before 2026.
- In 2026 and 2027, your plan may decide to join the demonstrations and may shift how it handles GLP-1 drugs that are prescribed mainly for obesity versus other diagnoses.
- It will be important to talk to your prescriber about how your conditions are documented and which diagnosis codes they use, since that can affect which benefit pays.
For a deeper dive into how to find and compare GLP-1 prescribers online, you can read our guide on finding an online GLP-1 provider (GLP Winner guide) and our breakdown of Trump’s $150 Ozempic announcement (GLP Winner analysis).
Timeline: what to expect between now and 2027
Here is the short version, based on what has been publicly reported.
- Late 2025
Novo Nordisk and Eli Lilly start rolling out lower cash prices and promotional offers for Wegovy, Ozempic, and Zepbound. (Reuters) (People health coverage)
The Trump administration publishes more details on the TrumpRx portal and on the Medicare demonstrations. - January 2026
TrumpRx is expected to open, giving all adults in the United States access to the new self pay prices through manufacturer programs and partner services. (Benefits and Pensions Monitor) - April 2026
The Section 402 Part D demonstration begins for Medicare Advantage and Part D plans that opt in. This is the first wave of Medicare coverage for GLP-1 obesity medications. (Obesity Action Coalition) - January 2027
The CMMI Medicare demonstration starts to keep coverage going and possibly expand it based on data from the first phase. (Obesity Action Coalition)
These are demonstration projects, which means they can be changed or ended by future administrations. Groups like the Obesity Action Coalition are still pushing Congress to pass the Treat and Reduce Obesity Act so Medicare coverage of obesity medications becomes permanent in law. (Obesity Action Coalition)
How to check your own coverage
Here is a simple checklist you can work through, or share with a parent or grandparent.
- Find out what kind of Medicare you have.
Look at your card or your plan documents.
If you are on Original Medicare, you probably also have a separate Part D drug plan. If you have one card from a private company that says “Medicare Advantage,” that plan usually includes your drug coverage. - Call your plan’s member services number.
Ask two clear questions:
“Will this plan join the new Medicare demonstration to cover GLP-1 obesity medications in 2026 and 2027”
“If yes, what will my monthly copay be, and will there be any special rules like prior authorization or step therapy” - Talk with your doctor or nurse practitioner.
Ask whether your BMI and health history might fit the early criteria for GLP-1 obesity medications under Medicare.
Ask them to walk through risks, benefits, and side effects, especially if you have heart disease, kidney disease, eye problems, or other complex conditions. - Compare options if your plan will not join.
Ask your clinician if a GLP-1 makes sense for you at all.
If it does, you may want to compare telehealth providers and cash pay options that align with the new TrumpRx pricing or manufacturer programs. GLP Winner can help you compare telehealth GLP-1 options side by side so you can see costs, requirements, and user reviews in one place.
What could still change
A few important caveats:
- These Medicare changes rely on demonstration authority, not a full change in the law. A different administration, or even this one, could scale them back later if costs or safety concerns look worse than expected. (Obesity Action Coalition) (Obesity Medicine Association)
- Budget analysts have warned that broad coverage of GLP-1 obesity medications could cost Medicare tens of billions of dollars over time, even at the new lower prices, which is why tight eligibility rules and plan opt-in are part of the design. (Congressional Budget Office) (American Action Forum)
- Clinical questions remain about how long people should stay on GLP-1 drugs, how to manage side effects in older adults, and how these medicines fit with other treatments you may already have.
The bottom line: the door to Medicare coverage of GLP-1 obesity medications is finally opening, but it will not swing open all at once. It will open plan by plan, state by state, and person by person.
Frequently asked questions
Will Medicare really cover Wegovy or Zepbound just for weight loss?
If the demonstrations move forward as described, some Medicare Advantage and Part D plans will be able to cover FDA approved GLP-1 obesity medications for people who meet the BMI and health criteria. You will still have to check whether your specific plan chooses to join and whether you qualify.
How much will I pay each month for my GLP-1 if I qualify?
Early information suggests a $50 monthly copay per GLP-1 obesity medication for people in participating plans, with Medicare and the plan paying the rest of the $245 price. That copay should count toward your Part D out of pocket maximum.
What if my Medicare plan does not join the new program to cover GLP-1s?
You might still have GLP-1 coverage for diabetes or heart disease indications, but not specifically for obesity. If you and your doctor decide an obesity indication is important, you may need to look at the new TrumpRx cash prices or other assistance options.
Will this help people on Medicaid too?
Yes, potentially. States will have the option to buy GLP-1 obesity medications at the same $245 price. If your state chooses to join, your Medicaid plan may cover these treatments with very low copays or none at all.
Could Medicare take this coverage of GLP-1s away later?
The demonstrations are temporary by design. Medicare will study the results and costs and can change or end the programs. Long term stability will likely require Congress to pass a law like the Treat and Reduce Obesity Act.
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