Are Weight Loss Drugs About to Get Less Expensive?

However, the direct-to-consumer prices announced by the administration appear to be lower.

“Bringing the price down really is going to impact those people who either don’t have insurance for [GLP-1s] and have been paying out of pocket, or alternatively, those people who have chosen to go the route of purchasing them as compounded versions,” says Cristy Gallagher, with the STOP Obesity Alliance at George Washington University’s Milken Institute School of Public Health.

Compounded GLP-1s are altered formulations made by a pharmacy, not the manufacturer. They have become popular through telehealth companies, which prescribe and sell them at much lower prices than the brand versions. However, the FDA has warned that they do not undergo federal review for safety, effectiveness and quality before they are marketed. 

With lower prices for out-of-pocket purchasing, “there might be an opportunity for people to switch over to the actual molecules through the company,” Gallagher says. “We just don’t know exactly everything that’s in some of these compounded medicines.”

If you have Medicare or Medicaid, accessing a GLP-1 could become easier and more affordable.

Medicare currently covers GLP-1s for diabetes and other approved ailments — such as obesity in conjunction with heart disease — but is legally barred from covering the medication for weight loss alone. However, the announcement from health officials says the new low prices for the federal insurance program “will enable Medicare to cover Wegovy and Zepbound for patients with obesity and related comorbidities [co-occurring diseases] for the first time.” 

Beneficiaries who will be eligible for lower-cost GLP-1 medications include individuals with a body mass index (BMI) of 27 or greater who have prediabetes or a history of cardiovascular disease; individuals with a BMI greater than 30 who have heart failure with preserved ejection fraction, uncontrolled hypertension or chronic kidney disease; and individuals with a BMI greater than 35. Coverage is expected to kick in around the middle of next year.

In the meantime, and especially because it’s Medicare open enrollment, Gallagher suggests looking for a health plan that covers the medications you are currently taking. If you have a Medicare health plan, consider other benefits that could help you with weight management, such as nutrition counseling.

“And if you are on a [GLP-1] and you’re turning 65, perhaps you’ll be able to purchase it through the TrumpRx market to sort of hold you over for a couple months until you know exactly what’s being covered [by Medicare] and whether your health plan will cover it or not,” Gallagher says.

It’s also important to note that the price of Ozempic and Wegovy was already being negotiated as part of the new Medicare drug price negotiation program. The negotiated price will be announced later this month and will become available in 2027. 

When it comes to Medicaid, only a dozen or so state programs cover GLP-1s for weight loss. It’s unclear whether this will result in more states covering these products.

If you get a GLP-1 through private insurance, or want to, pressure for lower prices could have a positive impact. 

Current coverage through private insurance plans for these medications, when prescribed for weight loss, can be spotty, which is why people with insurance often pay out-of-pocket for the drugs or have high copays. And a lot has to do with their prices, which are “breaking the budgets” of insurance companies, says Dr. Richard Siegel, an endocrinologist and codirector of the Diabetes and Lipid Center at Tufts Medical Center.

Experts interviewed for this article say they expect that increasing pressure for lower prices for GLP-1s will help expand access through private insurance. The introduction of more GLP-1 medications to the market, as they receive FDA approval, will also help.

“Our hope is that as the prices come down, more health plans will be more willing to cover the medications,” Gallagher says.

The potential impact

Obesity rates have climbed over the last decade, with the latest federal data showing nearly 40 percent of U.S. adults affected. And these escalating rates bring heightened risks for other serious obesity-related health conditions, including stroke, heart disease and certain cancers.

GLP-1 medications, however, can help many people lose a significant amount of weight and lower their risks for these other conditions. Studies have found that the drugs can improve heart and liver health and can treat sleep apnea in overweight adults. The medications have also been shown to reduce complications from kidney disease and even protect the brain.

Siegel says the current cost of these medications “is definitely a barrier” and that often, patients who could benefit from a GLP-1 are “on other expensive medications” as well. Lowering the cost of GLP-1s for people could have a significant impact on their health.

“We’re starting to finally get some research showing that people who have been on these medications, their health improves,” Gallagher says, and they’re able to go off medications for things like high blood pressure, high cholesterol and more.

“If blood pressure gets better and diabetes improves and arthritis improves, hopefully it would end up really reducing costs of care,” Siegel says.

Working with your doctor is still important 

That said, GLP-1 medications for weight loss are not for everyone, and they can cause unpleasant, even serious, side effects, including gastrointestinal issues like nausea and diarrhea, and pancreatitis, an inflammation of the pancreas.

As people talk about GLP-1s becoming more accessible, it’s important to keep in mind that they are still prescription medications, so working with your doctor to determine whether you might benefit from one is key, says Nick Fabrizio, associate teaching professor in the health policy program at Cornell University.

“One thing I have been emphasizing is that these medications by themselves are effective, but they really need to be used as part of an overall plan which includes significant counseling in terms of nutrition and activity, especially for older adults,” Siegel says. “People lose muscle and can potentially lose bone,” which is why working with professionals is so important.