However, the direct-to-consumer prices announced by the administration appear to be lower.
“Bringing the price down really is going to impact those people who either don’t have insurance for [GLP-1s] and have been paying out of pocket, or alternatively, those people who have chosen to go the route of purchasing them as compounded versions,” says Cristy Gallagher, with the STOP Obesity Alliance at George Washington University’s Milken Institute School of Public Health.
Compounded GLP-1s are altered formulations made by a pharmacy, not the manufacturer. They have become popular through telehealth companies, which prescribe and sell them at much lower prices than the brand versions. However, the FDA has warned that they do not undergo federal review for safety, effectiveness and quality before they are marketed.
With lower prices for out-of-pocket purchasing, “there might be an opportunity for people to switch over to the actual molecules through the company,” Gallagher says. “We just don’t know exactly everything that’s in some of these compounded medicines.”
If you have Medicare or Medicaid, accessing a GLP-1 could become easier and more affordable.
Medicare currently covers GLP-1s for diabetes and other approved ailments — such as obesity in conjunction with heart disease — but is legally barred from covering the medication for weight loss alone. However, the announcement from health officials says the new low prices for the federal insurance program “will enable Medicare to cover Wegovy and Zepbound for patients with obesity and related comorbidities [co-occurring diseases] for the first time.”
Beneficiaries who will be eligible for lower-cost GLP-1 medications include individuals with a body mass index (BMI) of 27 or greater who have prediabetes or a history of cardiovascular disease; individuals with a BMI greater than 30 who have heart failure with preserved ejection fraction, uncontrolled hypertension or chronic kidney disease; and individuals with a BMI greater than 35. Coverage is expected to kick in around the middle of next year.
In the meantime, and especially because it’s Medicare open enrollment, Gallagher suggests looking for a health plan that covers the medications you are currently taking. If you have a Medicare health plan, consider other benefits that could help you with weight management, such as nutrition counseling.
“And if you are on a [GLP-1] and you’re turning 65, perhaps you’ll be able to purchase it through the TrumpRx market to sort of hold you over for a couple months until you know exactly what’s being covered [by Medicare] and whether your health plan will cover it or not,” Gallagher says.
It’s also important to note that the price of Ozempic and Wegovy was already being negotiated as part of the new Medicare drug price negotiation program. The negotiated price will be announced later this month and will become available in 2027.
When it comes to Medicaid, only a dozen or so state programs cover GLP-1s for weight loss. It’s unclear whether this will result in more states covering these products.
If you get a GLP-1 through private insurance, or want to, pressure for lower prices could have a positive impact.
Current coverage through private insurance plans for these medications, when prescribed for weight loss, can be spotty, which is why people with insurance often pay out-of-pocket for the drugs or have high copays. And a lot has to do with their prices, which are “breaking the budgets” of insurance companies, says Dr. Richard Siegel, an endocrinologist and codirector of the Diabetes and Lipid Center at Tufts Medical Center.