President Donald Trump greeted him agreement to reduce prices on popular weight loss drugs as a game-changer that promises to make Wegovy and Zepbound more accessible to millions of Americans.
But major gaps in the plan could weaken its impact, drug policy experts say: Some drugs for which the administration promised rebates have not yet been approved by the Food and Drug Administration; lower prices for people paying out of pocket appear to apply only to the lowest doses of drugs; and the agreement does not expand Medicare coverage to people seeking treatment only for weight loss.
“This is a situation where we have more questions than answers,” said Juliet Kubanski, deputy director of the Medicare policy program at KFF, a nonpartisan health policy research group. “Based on what we haven't heard, it suggests there's a lot that the administration itself hasn't even worked out yet.”
“It just seems,” she added, “that he’s a little too soft right now.”
The announcement marks one of the most ambitious efforts yet to address the high cost of weight-loss drugs Wegovy and Zepbound in the United States. keep list prices above $1,000 per monthcost, which Both Republicans and Democrats criticized too high, especially compared to what other countries pay.
Administration officials say there is still time to iron out the details before the lower prices take effect. Lower prices that will be available through TrumpRx self-payment administrative platformis not expected until the end of the year, and changes to the Medicare and Medicaid programs will not take effect until mid-2026.
“I think the administration deserves credit for continuing to try to push the envelope in finding ways to lower prescription drug prices in the United States,” Kubanski said. She said KFF survey shows that health care costs, including prescription drugs, are a top concern for Americans.
Art Kaplan, director of medical ethics at New York's Grossman School of Medicine in New York, said the deal, while ambitious, was missing important details.
“It’s just unclear what it’s going to look like, how the programs are going to work,” Kaplan said. “It’s impossible to tell from what’s happening.”
Unapproved drugs
Some forms of the drugs included in the deal have not yet received FDA approval. These include oral versions of weight-loss drugs that are still in development or FDA review, as well as Eli Lilly's new multi-dose pens that have not yet been approved, but those versions are included in the pricing agreement, according to the drugmaker.
Lawrence Gostin, director of the O'Neill Institute for National and Global Health Law at Georgetown University, said that makes the administration's promises premature because lower prices won't be able to take effect until the products hit the market.
“It is foolhardy to negotiate prices for products that the FDA has not yet approved as safe and effective,” Gostin said. “The administration is getting ahead of its own security agency.”
Novo Nordisk's oral version of Wegovy is under FDA review. A decision is expected in the coming weeks.
A multi-dose version of Zepbound is under FDA review, Lilly said. The company has not yet provided the agency with its diet pill orforgliprone.
Lilly CEO David Ricks told NBC News' Tom Llamas on Top Story that the FDA would quickly review the pill. “As part of the deal, they agreed to give us expedited approval,” Ricks said.
Different doses, different prices.
The White House said both the pills and the pens will be available at reduced prices for people who pay out of pocket.
Initial doses of the diet pills will cost $149 for a month's supply, and the shots will cost an average of $350 for a month's supply, the White House said. The price of the injections is expected to drop to about $250 within two years, it said.
But people may end up paying more.
When people start taking a weight loss drug, they start with the lowest dose possible—the starting dose—to allow the body to get used to the drug. However, over the course of several months, they increase the dose until they reach a dose that is effective for weight loss. Wegovy comes in five doses and Zepbound comes in six, with the most weight loss seen at the highest doses.
Administration officials said initial doses of GLP-1 tablets would cost $149 a month, but did not specify what the higher doses would be.
On injections, the White House's exact language was vague: Initially, the “weighted average” price for shots will be $350 per month. Lilly, however, said Zepbound will be available in the lowest dose for $299 per month, with additional doses costing up to $449. A Novo Nordisk spokesman did not specify whether the doses would have different prices, but said it plans to release updated cost information “in the coming weeks.”
That means patients paying through TrumpRx could end up paying much more than the administration's announced prices, especially if patients don't stay on the lowest doses for long, Kaplan said.
Limited coverage
As part of the deal, Lilly and Novo Nordisk will charge Medicare and Medicaid $245 for a month's supply of shots, likely resulting in savings for the programs. Costs for Medicare beneficiaries will be capped at $50 per month. Medicaid members often have no copay.
But not everyone with Medicare or Medicaid is eligible.
Under the agreement, Medicare will continue to cover weight-loss drugs for people who are overweight or obese and have other medical conditions, such as heart or kidney disease. The agreement does not apply to people using the drugs only for weight loss. According to KFF's Kubanski, Medicare is legally unable to cover weight-loss drugs.
The lack of expanded coverage is a significant oversight, said Stacy Dusetsina, a professor of health policy at Vanderbilt University in Nashville, Tennessee.
Medicare is one of the largest payers in the country, and without greater coverage, millions of patients will remain in default even as the administration touts lower costs.
“You would have to change the law or go through several regulatory steps to be able to offer coverage beyond the indications already covered,” Dusetsina said.
A White House official said the administration wanted to lower prices first for patients who would benefit the most, such as those with risk factors associated with obesity.
It's possible that the administration could eventually expand Medicare coverage through a pilot program. Ricks, Lilly's CEO, said at a briefing Thursday that the government plans to launch the program in spring 2026, which will be voluntary for Medicare plans.
However, Dusetsin said there are some challenges that Medicare plans will have to consider.
“Plans will have to think about how many more people might be interested in registering and using these drugs and how that will impact their cost,” she said. “So, again, it’s not entirely clear to me how this will be implemented and how soon Medicare beneficiaries will expect prices to come down.”
Ricks said the pilot would be “at no cost” to the plans.
Dr. Shawna Levy, an obesity medicine specialist and medical director of the Tulane Weight Loss Center in New Orleans, said the deal is a “step in the right direction” but worries whether the administration is exaggerating the potential savings.
“As a community of people living with obesity, I think we will remain skeptical about this deal until we see how it actually plays out,” Levy wrote in an email.
