The Trump administration is delaying a pilot program where Medicare would cover the costs of GLP-1 weight-loss drugs, such as Wegovy and Zepbound, after major insurers declined to participate.
President Donald Trump has mentioned on a few occasions the popularity of weight-loss drugs, or as he refers to them, “fat shot.”
Medicare provides health care to older Americans and more than 55 million people are enrolled in the program. The Trump administration had sought a pilot program for Medicare to cover the cost of the drugs. But it is now shelving the program after health insurance companies were wary of participating.
Last year, Trump promoted his deals with weight-loss drug manufacturers Eli Lilly and Novo Nordisk to cut drug prices in return for access to a new pool of patients.
The pilot program, dubbed BALANCE, would have seen insurance companies that participate in Medicare coverage pay for drugs such as Wegovy or Zepbound as a regular benefit. That would have meant a copay of $50 for the drugs – far less than the hundreds of dollars consumers are currently spending.
Those on Medicare and already on the drugs will still be covered through a new transitional program that starts in July and runs through the end of 2027. But, Medicare will foot the bill, not the individual insurance companies, according to Axios.
The delay will allow the U.S. Centers for Medicare & Medicaid more time to figure out the best way to move forward with the pilot, Axios noted.
Medicare insurance companies admitted the concerns with the program, and one addressed them with investors this week.
“There are some notable challenges and outstanding questions with the currently planned structure,” Bobby Hunter, head of UnitedHealth’s Medicaid division, said during the company’s earnings call Tuesday. UnitedHealth is the largest seller of Medicare Advantage.
Trump has touted his program for lower drug prices as “tremendous savings” for people on Medicare. Lowering the cost of prescription medications has been a priority for the president, who has cut deals with other pharmaceutical companies to lower the cost of popular drugs.
However, lowering the cost of GLP-1s has been more difficult.
Without insurance, GLP-1 injectables can cost more than of $1,000 per month. However, many manufacturers offer coupons for customers to cut that monthly cost. For example, Novo Nordisk charges $349 per month for Wegovy. Ozempic runs about $349 a month for 0.25 mg, 0.5 mg, or 1 mg doses; for a dose of 2 mg it costs $499.
Eli Lily charges anywhere from $499 to $1,086 per month for Zepbound, depending on the dose. A 2.5 mg dose costs about $299 per month, but a 12.5 mg dose costs $699.
The medications offer significant benefits to people with diabetes or obesity – lowering blood sugar, inducing weight loss, improving fatty liver disease and reducing the risk of cardiovascular disease.
Roughly one in eight adults says they’ve used a GLP-1 to lose weight or treat a chronic condition, according to KFF.
Like all medications, GLP-1s also come with side effects, with some users reporting extreme vomiting, blindness, digestive problems and more.
