What you need to know
On Nov. 6, 2025, the White House announced new agreements with Eli Lilly and Novo Nordisk to reduce prices for leading diabetes, obesity and one migraine medication, including Ozempic, Wegovy and Zepbound. Under this arrangement, the lowest dose of these glucagon-like peptide-1 (GLP-1) agonist medication therapies will be offered for $149–$389/month through TrumpRx.gov.
TrumpRx.gov will function as a publicly accessible portal providing consumers with manufacturer-direct pricing for select products. In addition to GLP-1 discounts, both Eli Lilly and Novo Nordisk have agreed to offer their primary care medications at either Most Favored Nation (MFN) or net pricing on TrumpRx.gov. Newly introduced drugs from these manufacturers will be consistently priced at MFN rates for all users.
Prime Therapeutics (Prime) is working across our teams and with external partners to understand the evolving direct-to-consumer (DTC) market and explore solutions that support affordability, access, and member satisfaction. We’ll keep clients informed as this new channel develops.
Overview: Key details from the administration’s announcement
It is important to note that this information reflects what we know as of today, and details of these changes are still evolving.
Medicare & Medicaid:
- Ozempic, Wegovy, Mounjaro and Zepbound used for currently covered indications will be priced at $245/month.
- In Medicare, the criteria for coverage is expected to be for individuals with a BMI of at least 35, a BMI of at least 30 who have uncontrolled hypertension, kidney disease, or heart failure, or at least 27 who have prediabetes or established cardiovascular disease. The administration indicated that 10% of Medicare beneficiaries would qualify.
- Coverage will expand to include obesity for certain individuals, with a $50 monthly co-pay for all covered indications in Medicare.
- The prices will be $245/month for Medicare, with state Medicaid programs also able to access these lower prices.
- Centers for Medicare and Medicaid (CMS) will launch a voluntary 2026 demonstration allowing states to access MFN-level Medicaid pricing through manufacturer rebates and standardized coverage terms.
- A Medicare pilot is expected, with Eli Lilly’s CEO noting the administration’s plans for a voluntary Part D demo in spring 2026 that could become mandatory in 2027; details are still pending.
TrumpRx.gov:
- Once approved, oral GLP-1 therapies are expected to start at $149/month.
- Injectable and oral GLP-1 pricing is expected to initially average $350/month, trending down to an average of $245/month over the next 24 months.
- No official start date has been announced for the availability of these products on the TrumpRx.gov website, but CMS Administrator, Dr. Mehmet Oz, noted in the White House press conference on Nov. 6 that TrumpRx.gov would be open to the public before the end of the year.
Additional highlights:
- The agreement targets drugs with the highest annual expenditures in the U.S., benefiting adults with obesity, diabetes, heart disease and related conditions.
- Future drugs from participating manufacturers will launch at MFN prices.
- Eli Lilly and Novo Nordisk are investing heavily in U.S. manufacturing to support domestic supply chains.
Outstanding questions
While this announcement signals a significant policy shift, there are several important questions Prime is working on with various internal teams to further address:
- When will the new pricing and coverage changes officially take effect?
- Are there more details on how commercial health plans will be able to access TrumpRx pricing or negotiate similar terms?
- Will manufacturers extend MFN-level prices to commercial rebate or fee-for-service contracts?
- How will this agreement impact existing contracts, rebate/administrative fee structures, and utilization management strategies?
- Will State Medicaid programs opt into the expanded coverage and pricing model?
- How will future GLP-1 products made by other manufacturers be affected or respond?
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