President Donald Trump has announced a significant deal to enhance Medicare coverage by including specific weight-loss medications. This initiative is poised to provide millions of older Americans access to important treatments like Ozempic and Wegovy. The announcement was made on November 6, 2023, in which Trump disclosed that agreements were reached with pharmaceutical companies Eli Lilly and Novo Nordisk.
Key Features of the Medicare Deal
The new policies aim to lower the costs of GLP-1 medications, which are essential for managing diabetes and obesity. Starting in 2026, pricing for these medications will be substantially reduced for Medicare and Medicaid beneficiaries.
- Ozempic: Reduced from $1,000 to $350 per month
- Wegovy: Decreased from $1,350 to $350 per month
- New medications will potentially be priced as low as $145 per month
This pricing structure will be available through the soon-to-launch TrumpRx.gov, set to begin operations in January 2026. Trump emphasized the financial benefits, clarifying that patients could pay around $150 instead of the previous $1,300 monthly cost.
Policy Changes Affecting Coverage
Historically, Medicare has not covered medications specifically designed for weight loss due to constraints in the 2003 Medicare Modernization Act. However, recent FDA approvals for new uses of drugs like Wegovy have led to policy evaluations for broader Medicare inclusion.
The Centers for Medicare & Medicaid Services (CMS) recently indicated that Medicare Part D plans might now include certain anti-obesity drugs if they have a medically accepted use. Nonetheless, actual Medicare coverage for weight loss alone still faces obstacles due to long-standing federal restrictions and budget concerns.
Fiscal Implications of the Coverage Expansion
This new coverage policy comes with significant financial implications. The Congressional Budget Office (CBO) predicts that Medicare’s inclusion of anti-obesity drugs could add at least $35 billion to federal spending from 2026 to 2034. The estimated average cost per user in 2026 is projected to be around $5,600, although competitive pricing may reduce these expenses over time.
As of now, the national debt has surpassed $38 trillion, raising alarms among budget watchdog organizations regarding the increasing financial strain on the country’s economy.
The Obesity Epidemic in America
Obesity is a major public health concern, affecting approximately 40% of U.S. adults. The Centers for Disease Control and Prevention (CDC) reports that nearly 39% of Americans aged 60 and older also face obesity. Interestingly, recent trends indicate a minor decline in obesity rates across various states, potentially influenced by the rising availability of weight-loss medications.
