Medicare and Medicaid to Start Covering GLP-1 Drugs for Beneficiaries

On November 6, President Donald Trump announced the GENErating cost Reductions fOr U.S. Medicaid (GENEROUS) model with pharmaceutical companies Eli Lilly and Novo Nordisk.

The model extends GLP-1 coverage to Medicare and Medicaid beneficiaries. This is great news for your clients interested in weight loss drugs!

Without insurance coverage for GLP-1 medications, known by brand names Ozempic, Wegovy, Mounjaro, or Zepbound, individuals could spend anywhere from $900 to $1,300 a month. Previously, this group included Medicare beneficiaries without type 2 diabetes.

GLP-1 Medicare and Medicaid coverage will begin in 2026 through a pilot program. Here’s what you need to know to answer client questions around weight loss drugs covered by Medicare and Medicaid.

What GLP-1 Medications Could Be Covered?

Pharmaceutical companies Eli Lilly and Novo Nordisk are responsible for Ozempic, Wegovy, Mounjaro, and Zepbound. These two manufacturers produce the medications used to treat type 2 diabetes and manage weight loss for adults with obesity.

Drug manufacturers also mentioned that groundbreaking GLP-1 pills could be added to the program mid-2026 pending Federal Drug Administration (FDA) approval.

These drugs are the headliners participating in the program to extend coverage to Medicare beneficiaries. In the press conference with the Trump administration, drug manufacturers also mentioned that groundbreaking GLP-1 pills could be added to the program mid-2026 pending Federal Drug Administration (FDA) approval.

When Will Savings Begin for Beneficiaries?

In January, the Trump administration said they will debut a platform TrumpRx.gov where consumers can purchase the medications at a discount. More details could come about the program at the end of the year.

For consumers obtaining a GLP-1 through their Medicare coverage, these savings will begin mid to late-2026.

The timeline and specific cost for Medicaid coverage varies due to the nature of the program.

Savings for Medicare Clients

The GENEROUS model extends Medicare coverage to beneficiaries with obesity. Previously, only those with type 2 diabetes or cardiovascular disease could receive coverage for GLP-1 medications. It’s estimated that this expanded coverage will cover 10 percent of Medicare beneficiaries.

Expanded coverage of GLP-1 medications will cover 10 percent of Medicare beneficiaries.

Beneficiaries with Part D benefits will be phased into coverage in three stages through a pilot program.

• Phase 1: Overweight individuals with a Body Mass Index (BMI) greater than 27, individuals with prediabetes, or diagnosed cardiovascular disease.

• Phase 2: Overweight individuals with a BMI greater than 30, individuals with uncontrolled hypertension, kidney disease, or heart failure.

• Phase 3: Overweight individuals with a BMI greater than 35.

Individuals wishing to obtain one of the drugs intended for weight loss (Wegovy and Zepbound) will be able to obtain coverage if they are obese or overweight with one related condition.

Note: Medicare beneficiaries wishing to receive a GLP-1 for weight loss alone without a related risk factor will not be eligible for savings under the GENEROUS model.

Savings for Medicaid Beneficiaries

To mitigate risks associated with lifelong obesity, the Trump administration also wishes to extend coverage to Medicaid. Through the GENEROUS model, state Medicaid programs will have to opt in to provide lower-priced GLP-1 medications to individuals receiving Medicaid.

As the program stands, states will have to issue a letter of intent, and then they will be invited to participate in the pricing agreement later. Through this agreement, specific costs and who is able to receive the medication will be negotiated.

Due to the “opt-in” nature of this program, it’s difficult to estimate how many Medicaid beneficiaries could access lower pricing for these medications.

What Will a GLP-1 Medication Cost?

Starting doses of Wegovy and Zepbound will cost the Medicare and Medicaid programs $350 a month and decrease in cost over a two-year period.

The lowest doses of drugs used to treat type 2 diabetes, Ozempic and Mounjaro, will cost the programs $245 a month and decrease in cost over two years as well.

A Medicare beneficiary who qualifies for coverage under the expanded criteria or the Part D phase-in plan will pay only $50 a month for a GLP-1 medication. This is a notable savings from what beneficiaries are spending on GLP-1s today.

Why This Program Is Critical for Americans’ Health

GLP-1 medications are a valuable treatment for those with type 2 diabetes, lowering blood sugars and with continued use, A1C levels as well. The treatment of type 2 diabetes with GLP-1 has been a proven method since 2005. It was discovered that weight loss was also associated with these drugs, and through developing more GLP-1 medications in the last several years, their popularity has grown.

The GENEROUS model is the first significant stride toward more affordable GLP-1 coverage for a wider group of individuals.

It’s difficult for many to access these medications due to the costs without insurance, and many prescribers also require prior authorization from a doctor. The GENEROUS model is the first significant stride toward more affordable GLP-1 coverage for a wider group of individuals.

Obesity increases the risk for death anywhere from 22 to 91 percent, according to research from University of Colorado Boulder. Providing access to proven GLP-1 medications could benefit health outcomes for a wide group of Americans and reduce the strain on the health care system associated with treating diabetes and related conditions.

How to Notify Clients of This Update

For your clients with a Part D plan that could qualify for GLP-1 coverage as part of the GENEROUS model, let them know to speak to their doctor about these treatments if they are interested.

It’s also possible that many of your clients could already take these medications. Let them know that they could be paying less for them by mid to late-2026. We will keep agents informed about the changes that come with this pricing model.

President Trump’s GENEROUS model could make major strides for making GLP-1 medications more affordable for many. Treating diabetes and obesity to improve health outcomes for Americans has become a priority for this administration.

Register with Ritter today for free to have access to online contracting through Contract Now with carriers that offer Part D coverage that could participate in this program. As a Ritter agent, you’ll also have access to a team of knowledgeable sales reps for support through policy changes as more.

^*Newly registered agents must speak with their sales specialist to unlock Contract Now.