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When the Trump administration introduced earlier this yr that it might not finalize a provision proposed by the Biden administration to broaden Medicare and Medicaid protection of GLP-1s, many advocates responded with deep disappointment.
However this month, the Trump administration unveiled its personal efforts to broaden entry to the favored weight reduction medication, asserting an settlement with GLP-1 producers Eli Lilly and Novo Nordisk. The settlement will permit sufferers to entry GLP-1s for considerably cheaper costs by TrumpRx, a government-run direct-to-consumer drug platform. It additionally reduces costs beneath Medicare and Medicaid, and allows Medicare to cowl GLP-1s for weight problems for the primary time.
Apart from hanging a take care of the Trump administration, Eli Lilly can also be charting a brand new course to broaden entry to GLP-1s. The corporate introduced plans on Friday to construct an employer-focused mannequin for weight problems administration medicines, which can embody versatile profit design choices for weight problems administration care, a devoted pharmacy community and weight problems administration applications by third events. This can turn out to be obtainable in 2026.
Whereas many are applauding the Trump administration for taking this step to broaden entry to GLP-1s, some consider that particularly concentrating on weight reduction medication truly does little or no to deliver down total prescription drug prices.
“I feel that specializing in market options on GLP-1s alone misses the mark, as a result of it’s a market downside,” mentioned Chris Deacon, principal and founding father of VerSan Consulting. “[Whether it’s] GLP-1s or different medicines, we’ve got an issue of a whole lack of transparency for the purchaser.”
One other professional echoed these feedback, stating that whereas it is a optimistic transfer, there must be a broader effort as a way to successfully deliver down drug prices completely.
“It is a step in the fitting route,” mentioned Edgar Asebey, an FDA regulatory legal professional at Frier Levitt. “A coverage initiative that’s extra of a blanket coverage with branded medication could be a lot better for the American sufferers.”
What’s the Trump administration’s deal?
In accordance with a reality sheet, the Trump administration’s take care of Novo Nordisk and Eli Lilly has a number of components, together with:
- Permitting shoppers to entry Ozempic and Wegovy for $350 when bought by TrumpRx, in comparison with the record value of over $1,000
- Permitting shoppers to entry Zepbound and Orforglipron (if accepted) for $346 by TrumpRx, in comparison with the record value of over $1,000
- If the FDA approves the Wegovy capsule, the preliminary dose might be obtainable at $150 monthly by TrumpRx
- Medicare costs for Ozempic, Wegovy, Mounjaro and Zepbound might be $245, and Medicare might be allowed to cowl Wegovy and Zepbound for weight problems for the primary time. Medicare beneficiaries can pay a co-pay of $50 monthly
- State Medicaid applications may even have entry to those costs for GLP-1s. States can presently resolve whether or not to cowl weight problems medication beneath Medicaid, and 13 states achieve this, based on KFF
- Prices for different Eli Lilly and Novo Nordisk medication may even be diminished when bought by TrumpRx, together with migraine remedy Emgality, diabetes medicine Trulicity and insulin merchandise NovoLog and Tresiba
What do the specialists suppose?
Though the Trump administration’s deal lowers the costs of GLP-1s within the U.S., these costs are nonetheless considerably increased than in different international locations, famous Deacon of VerSan Consulting. For instance, the worth of Ozempic is $96 in Sweden, $93 within the U.Ok., $87 in Australia and $83 in France, based on KFF.
She added that as a way to make an precise distinction on prescription drug prices, the main target shouldn’t solely be on GLP-1s.
“I feel staying centered on GLP-1s is a really sensible, tactical transfer by the trade, as a result of it’s what individuals need,” she mentioned. “It appears like we’re shopping for off the American individuals and kind of satisfying their want for reform within the pharmaceutical area by specializing in GLP-1s as a result of that’s what all people’s speaking about, and that’s what so many individuals need. … In the meantime, it’s your entire kind of chain throughout pharmaceutical buying that basically wants reform.”
Asebey of Frier Levitt agreed with this, stating {that a} main cause different international locations have considerably decrease costs for GLP-1s is due to a single payer system. And whereas he believes it is a nice first step, there are numerous different excessive value medication that have to be lowered, like most cancers medication.
“This isn’t actually as advantageous as if we had a single payer system, as a result of we don’t know … whether or not that is going to have an effect on well being plans beneath employers,” he mentioned. “Sure, non-public profit managers are negotiating this stuff, however that’s separate from what the White Home is doing proper now. That’s nonetheless a query mark. These aren’t the one medication. These are the preferred ones, however different essential medication are nonetheless very costly. What’s going to occur to them?”
The U.S. is way from transitioning to a single payer system. And within the absence of a single payer system, Asebey hopes that the administration continues to take related actions to decrease drug prices, even when it’s extra “piecemeal.”
He additionally made this suggestion:
“I feel it might be nice if the Trump administration introduced that there’s going to be the highest 40 branded medication that come out yearly and to be added to a formulary that they’ll negotiate drug pricing. They’ve completed it with Novo Nordisk and with Lilly. Clearly, neither a type of corporations goes broke, they usually can afford to proceed accessing the U.S. market at very worthwhile value factors. However I feel President Trump ought to use that bully pulpit for the nice of a higher variety of Individuals, not simply those that wish to shed weight or are diabetic.”
It’s price noting that there have been a number of different makes an attempt to rein in drug prices. For instance, there are efforts to advance the 340B Drug Pricing Program, although some consider this gained’t repair this system’s points. Congress has additionally pursued PBM reforms, although these efforts have but to materialize.
Some steps have been launched to assist employer-sponsored plans as effectively, akin to Eli Lilly’s announcement on Friday to construct an employer-focused mannequin for weight administration medication. Digital well being corporations Waltz Well being and 9amHealth additionally introduced employer fashions on Friday to broaden entry to Eli Lilly weight problems administration medication. Nevertheless, these plans nonetheless goal weight reduction medication particularly, versus addressing drug prices as an entire.
In the meantime, a prescription drug advocate mentioned that Trump’s GLP-1 deal is “life-changing” for many who are reliant on these medication, however questioned the motives of drug corporations.
“Voluntary offers are depending on the ‘goodwill’ of corporations with an extended historical past of exploiting their energy to maintain costs excessive on the expense of sufferers,” mentioned Merith Basey, government director of Sufferers For Inexpensive Medication. “Eli Lilly and Novo Nordisk have moved in lockstep for years to lift insulin costs, so there’s actual concern that GLP-1 costs might rise once more simply as shortly as they’ve been lowered. Producers alone set launch costs – and a transparent reminder of why we urgently want reforms that rein them in.”
Like Deacon and Asebey, Basey believes that there must be efforts past GLP-1s as a way to really make a distinction. She argued that Medicare negotiation is presently the best software the U.S. has for reducing drug prices and that this program ought to be expanded.
“Decrease costs for GLP-1s will assist many individuals, and we’re glad to see that progress. However fixing the prescription drug market – not only one class of medicines – requires structural reforms that guarantee all sufferers can entry the prescribed drugs they want at a value they will afford,” she mentioned.
Photograph: Jason Dean, Getty Photos
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