Eli Lilly, Novo Nordisk to slash weight loss drug prices, offer some Medicare coverage

This is good news. And will help drive grey prices even lower🙂

"The event was delayed when a man who was standing behind Trump fainted."
He was reportedly a pharma rep
 
"Tirzepatide, the active ingredient in Eli Lilly’s Zepbound and diabetes injection Mounjaro, likely won’t be eligible for those negotiations until the end of the decade."
 
Says Zepbound and Mounjaro eligible for $50-149 per month on Medicare and Medicaid. That’s a game changer.
 
Too little too late for me ... but I'm happy for anyone who it does end up helping. Most insurance companies follow the state guidelines and Ohio pretty much bans coverage for weight loss drugs. Not a single plan on the marketplace covers them. I know, I checked.
 
So from $399 down to $349 for the starting doses compared to direct to patient and $449 down from $499 for all other doses for most people not covered on Medicare / Medicaid. $50 off is better than nothing, I guess… 🥴
 
https://www.fidelity.com/news/article/investment-news/202511061712BENZINGAFULLNGTH48706737
Under the new deal, Medicare and Medicaid will begin covering obesity medications, including GLP-1 drugs – short for glucagon-like peptide-1 receptor agonists– starting in April 2026.

Patients will see monthly out-of-pocket costs ranging from $50 to $350, depending on dosage and insurance coverage — a sharp reduction from the $1,000-plus price tags many currently face.

Eli Lilly CEO Says ‘Turning Point’ In Obesity Fight​

"This action today will really begin to change the arc of chronic disease in our country," Dave Ricks, CEO of Eli Lilly ( LLY ), said, adding that the reduced cost "opens up access for millions of Medicare beneficiaries."

He cited powerful results from Lilly's Zepbound (tirzepatide), noting its ability to reduce the progression from prediabetes to type 2 diabetes by 94% over three years and showing significant cardiovascular benefits in clinical trials.

Ricks also teased the arrival of Lilly's next-generation pill, orforglipron, a once-daily oral treatment that aims to improve patient convenience
 
It's wild how my perspective has changed. I look at this, shrug, and say "Who cares that you're dropping prices to three hundred bucks a month? I can get good, well-tested grey for two-fiddy bucks a YEAR. Don't pee on my leg and tell me the rain is nice this time of year."
 
Medicare will start covering obesity drugs for some patients for the first time starting mid-2026. Certain Medicare patients will pay a copay of $50 per month for all approved uses of injectable and oral GLP-1 drugs, including diabetes and obesity treatment. Starting doses of upcoming obesity pills from Eli Lilly and Novo Nordisk, pending approvals, will be $149 per month for everyone getting them through Medicare, Medicaid or TrumpRx.

- Great news for those who will be eligible!

Starting doses of existing injections like Novo’s Wegovy and Lilly’s Zepbound will be $350 per month on TrumpRX, but will “trend down” to $245 per month over a two-year period.

Still too much for a starting dose. This makes me think that this will only drive more people to compound and grey when the people they know who are eligible for Medicare coverage start getting their meds.
 
MsGizmo said:
Too little too late for me ... but I'm happy for anyone who it does end up helping. Most insurance companies follow the state guidelines and Ohio pretty much bans coverage for weight loss drugs. Not a single plan on the marketplace covers them. I know, I checked.
Click to expand...
Do they allow it for diabetics?
 
Rolltide61 said:
Do they allow it for diabetics?
Click to expand...
Oh, yeah. My mother is on Medicare and gets it. When she started her co-pay was a little over $100 per month but has since dropped to about $20 a month when they fixed the donut hole situation. My husband is also getting it from the insurance we get from the marketplace. I had to specifically search for a plan that covered it though. Not all of them did at the time. We started out paying about $50 a month to now paying $25 per month. When he was first prescribed it they TRIED to deny it and telling us that he had to take insulin first. We appealed that decision due to my husband being a truck driver and that it was against ODOT policy to have truck drivers who are insulin dependent due to the risk of sudden blood sugar levels dropping. The next year we switched to a difference company and they didn't give us a problem with it.

Since I am not a diabetic, I am on my own. Not a single plan in my state covers wegovy or zepbound.
 
If it does help people get access to the meds, I think that is wonderful -- and I don't want to take anything away from that. But this concerns me overall as it's may not be good for the grey market.

Lilly's market cap is about a Trillion dollars -- equivalent to the GDP of Switzerland. Ozempic is Lilly's cash cow. Why would Lilly agree to limit their cash cow? Why has their stock been rising since the announcement that prices will be cut? What's in it for them?

My own observation of the grey market, the folks that have had the most legal troubles have been folks involved with the oils, and with semaglutide.

Not Tirzepatide (more expensive!) Not Retatrutide (not even sold in the US!)

I suspect the White House has agreed to a harder stance against semaglutide in its various not-made-by-Lilly forms, to help Lilly protect its brand/profits. Lilly lowering the price of the entry level dose, is a defense against the "it's so expensive" argument.
 
4StrandKnot said:
Lilly's market cap is about a Trillion dollars -- equivalent to the GDP of Switzerland. Ozempic is Lilly's cash cow. Why would Lilly agree to limit their cash cow? Why has their stock been rising since the announcement that prices will be cut? What's in it for them?
Click to expand...
First, lets just start out with how cheap it is to make these drugs in the first place. Even the peptides we are buying directly from China is providing a huge profit.


People who are on Medicaid/Medicare have long been priced out of the GLP1 market unless they are a diabetic. So that's money the pharma companies were already not getting. Using the highest estimated cost to produce the drug of $5 and only the $245 price tag that I've seen they plan on charging ... that is STILL a profit of $240 a month per patient.

No one else is getting that lowered price BTW. All the people that have been paying the higher price .. well they are just going to have to continue to pay that higher price. The inclusion of Medicaid/Medicare patients is an EXPANDED market.
 
4StrandKnot said:
If it does help people get access to the meds, I think that is wonderful -- and I don't want to take anything away from that. But this concerns me overall as it's may not be good for the grey market.

Lilly's market cap is about a Trillion dollars -- equivalent to the GDP of Switzerland. Ozempic is Lilly's cash cow. Why would Lilly agree to limit their cash cow? Why has their stock been rising since the announcement that prices will be cut? What's in it for them?

My own observation of the grey market, the folks that have had the most legal troubles have been folks involved with the oils, and nwith semaglutide.

Not Tirzepatide (more expensive!) Not Retatrutide (not even sold in the US!)

I suspect the White House has agreed to a harder stance against semaglutide in its various not-made-by-Lilly forms, to help Lilly protect its brand/profits. Lilly lowering the price of the entry level dose, is a defense against the "it's so expensive" argument.
Click to expand...
Ozempic is Novo Nordisk, not Eli Lilly. Zepbound/Mounjaro is Eli Lilly.
 
MsGizmo said:
Update on how much my mother pays for her Ozempic with Medicare. It seems she can now get her prescription for free. I went to the pharmacy today and none of her meds cost anything out of pocket.
Click to expand...
It might be due being past the donut hole for the year. January it starts all over again.

Highly recommend 90 day fills if her insurance offers that (technically 84) and with the overlap the script can yield 5 fills in a year (15 boxes 4x Mounjaro in my case).
 
nonyabizznez said:
It might be due being past the donut hole for the year. January it starts all over again.

Highly recommend 90 day fills if her insurance offers that (technically 84) and with the overlap the script can yield 5 fills in a year (15 boxes 4x Mounjaro in my case).
Click to expand...
That's what I'm wondering too. Like on my regular plan, I've met my deductible so certain things are now free. But come January 1st, they're back to paying. Not sure if Medicare is the same or not.
 
nonyabizznez said:
It might be due being past the donut hole for the year. January it starts all over again.

Highly recommend 90 day fills if her insurance offers that (technically 84) and with the overlap the script can yield 5 fills in a year (15 boxes 4x Mounjaro in my case).
Click to expand...
Whatever it is I'm glad for her and everyone else that sees a price drop.
 
IshimaruKenta said:
That's what I'm wondering too. Like on my regular plan, I've met my deductible so certain things are now free. But come January 1st, they're back to paying. Not sure if Medicare is the same or not.
Click to expand...
Medicare was kind of the reverse of that .. before Obamacare fixed the donut hole it used to be that after Medicare paid so much for your prescriptions your costs would jump up until the new year started. It was annoying.
 
randompersonrandom said:
It's wild how my perspective has changed. I look at this, shrug, and say "Who cares that you're dropping prices to three hundred bucks a month? I can get good, well-tested grey for two-fiddy bucks a YEAR. Don't pee on my leg and tell me the rain is nice this time of year."
Click to expand...
So true! I'll stick to my grey. Thanks! I'm stocked up.
 
mlke6 said:
I"m excited to see how generic semaglutide works into everything next year.
Click to expand...
This will be interesting. It won't be generic in the US until 2031, but the US market will still be impacted by it becoming generic in Canada, Brazil, and China.
 
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