Medicare and Weight Loss Drugs: What Seniors Need to Know in 2026

If you've been hearing about drugs like Ozempic, Wegovy, and Zepbound but aren't sure what Medicare covers, you're definitely not alone.

Good news – Medicare will cover weight loss drugs starting mid-2026!

Learn about the November 2025 announcement, new $50 copays, and who qualifies for GLP-1 coverage.

Understanding Weight Loss Medications

GLP-1 medications (like Ozempic, Wegovy, and Rybelsus) work by mimicking a hormone in your body that helps:

• Regulate blood sugar levels
• Slow down digestion
• Create a feeling of fullness that lasts longer

Originally developed for diabetes management, these medications have shown remarkable effectiveness for weight loss and are increasingly prescribed for obesity treatment.

Why These Medications Matter

With over 40% of American adults considered obese according to the CDC, these medications address a significant health concern.

Obesity isn't just about weight; it's connected to serious health conditions including:

• Heart disease
• Type 2 diabetes
• Certain types of cancer
• Sleep apnea

Recent research suggests these medications may offer additional benefits beyond weight loss, potentially helping with:

• Reduced risk of cardiovascular events
• Improved management of alcohol cravings
• Better sleep quality for those with sleep apnea

The Journey of Medicare Coverage Changes

The story of Medicare coverage for weight loss drugs has been a rollercoaster in 2025.

What Happened in April 2025

In November 2024, the Biden administration proposed reinterpreting Medicare's statutory exclusion of weight loss drugs to allow coverage specifically for obesity treatment.

This would have expanded access to approximately 3.4 million Medicare beneficiaries with obesity.

However, on April 4, 2025, the Trump administration announced it would not implement this change.

The primary concerns were cost-related. The Congressional Budget Office estimated that covering these drugs would increase federal spending by $35.5 billion from 2026 to 2034.

Many seniors were disappointed, thinking the door had closed on Medicare coverage for these medications.

The Game-Changing Announcement: November 6, 2025

Then, everything changed.

On November 6, 2025, President Trump announced landmark deals with pharmaceutical giants Eli Lilly and Novo Nordisk that will transform access to GLP-1 medications for Medicare beneficiaries (and all Americans).

For the first time ever, Medicare will cover obesity medications for specific groups of beneficiaries through a pilot program.

The expanded coverage will be available through Medicare Part D plans starting mid-2026.

Who will qualify for coverage:

• Seniors who are severely obese (BMI greater than 35)
• Those who are overweight (BMI 27+) with prediabetes or cardiovascular disease
• Those who are obese with advanced kidney disease, heart failure, or uncontrolled hypertension

Approximately 10% of Medicare enrollees, which represents millions of people, will be newly eligible for coverage under these criteria.

Your GLP-1 Costs With Medicare

Medicare patients will pay a $50 monthly copay for GLP-1 medications, whether injectable or oral versions (once approved).

The pharmaceutical companies have agreed to slash prices dramatically:

For Medicare and Medicaid:

• Injectable GLP-1 drugs: $245 per month (down from $1,000-$1,400)

Note: The total cost of the medication is $245, but as a Medicare beneficiary, you only pay $50 of that. Medicare pays the remaining ~$195.

• Oral GLP-1 tablets (when approved): $149 per month for starting dose

Context: This represents a reduction to about one-ninth of current list prices. Medicare spent $5.7 billion on GLP-1s to treat diabetes in 2022 alone.

The TrumpRx Platform

Here's something that could help whether you're on Medicare or not: A new government website called TrumpRx is launching in January 2026, offering discounted medications purchased directly from pharmaceutical companies.

TrumpRx Pricing:

• Injectable GLP-1 drugs: Starting at $350 per month, trending down to $245 over two years
• Oral GLP-1 tablets (when approved): $149 per month for starting dose

This platform will be available for cash-paying customers who don't have insurance coverage or whose insurance doesn't cover these medications.

What About Existing Medicare Coverage?

Even before these new changes, Medicare Part D has covered GLP-1 medications, but only when prescribed for approved conditions other than weight loss alone.

Currently covered uses:

• Type 2 diabetes management
• Reducing cardiovascular risk in certain adults with obesity or overweight and established cardiovascular disease
• Obstructive sleep apnea (for some medications)

Weight loss medications prescribed solely for weight management have never been covered by Medicare Part D and technically still aren't under the new agreements.

However, the expanded criteria for obesity-related conditions in mid-2026 will effectively provide coverage for many seniors who previously didn't qualify.

Upcoming Oral Versions

Both Novo Nordisk and Eli Lilly are developing oral (pill) versions of their GLP-1 medications:

• Novo Nordisk's oral Wegovy: Currently under FDA review with a decision expected by the end of 2025
• Eli Lilly's orforglipron: Expected to launch in 2026

These oral versions will be priced at $149 per month for the starting dose through Medicare, Medicaid, and TrumpRx, making them even more affordable than the injectable versions.

What This Means for Price Negotiations

It's important to note that these new deals are separate from the Medicare Drug Price Negotiation Program under the Inflation Reduction Act.

Ozempic, Rybelsus, and Wegovy were selected in January 2025 for a second round of Medicare drug price negotiations, which would have resulted in new pricing taking effect in 2027.

The November 2025 agreements with the pharmaceutical companies will deliver price reductions much sooner – by mid-2026.

How Senior Allies Can Help

Navigating Medicare coverage decisions shouldn't leave you feeling confused or overwhelmed.

At Senior Allies, we're committed to:

• Helping you understand your current coverage options
• Keeping you informed about important Medicare changes
• Finding the best insurance coverage for your specific health needs and budget
• Providing ongoing support whenever you have questions

Our team has been guiding seniors through Medicare decisions for over 30 years, and we're ready to help you, too.

If you have questions about Medicare coverage for weight loss medications or any other healthcare needs, call us at 833-801-7999 to speak with a licensed agent who can help you understand your options and find the coverage that's right for you.

Note: Read more details in The White House fact sheet: Fact Sheet: President Donald J. Trump Announces Major Developments in Bringing Most-Favored-Nation Pricing to American Patients