Policy changes

White House

The November 6, 2025 and February 5, 2026 White House fact sheets both say that on May 12, 2025 the President signed an executive order titled “Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients,” and that on July 31, 2025 the President sent letters to leading pharmaceutical manufacturers. The November 6 fact sheet says five manufacturer deals had been announced since September 30, 2025. The February 5 fact sheet says 16 deals had been announced since that date, and that TrumpRx.gov launched with drugs from AstraZeneca, Eli Lilly, EMD Serono, Novo Nordisk, and Pfizer.

Stated May 12, 2025. The White House: Fact Sheet: President Donald J. Trump Launches TrumpRx.gov to Bring Lower Drug Prices to American Patients. Checked October 16, 2026.

White House most-favored-nation fact sheet

The November 6, 2025 White House fact sheet says agreements with Eli Lilly and Novo Nordisk would move Ozempic from $1,000 and Wegovy from $1,350 per month to $350 when purchased through TrumpRx, and Zepbound and orforglipron, if approved, from $1,086 per month to an average of $346. It says that if the FDA later approved a Wegovy pill or similar oral GLP-1s, the initial dose would be $150 per month through TrumpRx. It also says the Medicare prices of Ozempic, Wegovy, Mounjaro, and Zepbound will be $245, and that Medicare beneficiaries will pay a copay of $50 per month.

Stated November 6, 2025. The White House: Fact Sheet: President Donald J. Trump Announces Major Developments in Bringing Most-Favored-Nation Pricing to American Patients. Checked October 16, 2026.

Medicare drug price negotiation

The CMS fact sheet on negotiated prices for initial price applicability year 2027 lists one negotiated price of $274 for a 30-day supply of Ozempic, Rybelsus, and Wegovy, against a 2024 list price of $959 for a 30-day supply. Prices take effect beginning January 1, 2027. For three example packages, CMS lists a maximum fair price of $276.78 for one Ozempic 4 mg/3 mL pen (NDC 00169-4130-13), $276.78 for 30 Rybelsus 7 mg tablets (NDC 00169-4307-30), and $385.63 for four Wegovy 2.4 mg/0.75 mL pens (NDC 00169-4524-14). The PDF file was created November 25, 2025. The fact sheet says the negotiation period ended November 1, 2025. This negotiated price is separate from the Bridge $50 copay and the $245 Bridge net price.

Stated November 25, 2025. CMS: Medicare Drug Price Negotiation Program: Negotiated Prices for Initial Price Applicability Year 2027. Checked October 16, 2026.

LillyDirect self-pay, as announced

On December 1, 2025, Eli Lilly announced lower Zepbound single-dose vial prices on LillyDirect. With a valid prescription, the 2.5 mg starting dose is as low as $299 per month (previously $349) and the 5 mg dose is $399 per month (previously $499). Other approved doses are $449 per month on the Zepbound Self Pay Journey Program (previously $499). Lilly lists regular monthly prices outside that program as $599 for 7.5 mg, $699 for 10 mg, $849 for 12.5 mg, and $1,049 for 15 mg. Lilly says the Journey price for 7.5 mg, 10 mg, 12.5 mg, and 15 mg applies on the first fill and when the prescription is refilled within 45 days of the previous delivery, and that the 12.5 mg and 15 mg vials are $849 and $1,049 if refilled outside that window. This row is the December 1, 2025 announcement. LillyDirect did not return a price page on the October 16, 2026 check.

Stated December 1, 2025. Eli Lilly and Company: Lilly lowers the price of Zepbound (tirzepatide) single-dose vials. Checked October 16, 2026.

White House TrumpRx fact sheet

The February 5, 2026 White House fact sheet says the monthly price of Ozempic will fall from $1,028, and injectable Wegovy from $1,349, to an average of $350 and as low as $199, depending on dosage strength. It says the Wegovy pill will fall from $1,349 to as low as $149, depending on dosage strength, and Zepbound from $1,088 to an average of $346 and as low as $299, depending on dosage strength. The fact sheet says patients with valid prescriptions reach the discounts through coupons or manufacturer channels integrated into TrumpRx.gov.

Stated February 5, 2026. The White House: Fact Sheet: President Donald J. Trump Launches TrumpRx.gov to Bring Lower Drug Prices to American Patients. Checked October 16, 2026.

FDA approval

FDA announced on April 1, 2026 that it approved Foundayo (orforglipron) for use with a reduced-calorie diet and increased physical activity to reduce excess body weight and maintain weight reduction long term in adults with obesity, or in adults with overweight and at least one weight-related comorbid condition. FDA granted the approval to Eli Lilly and Company.

Stated April 1, 2026. FDA: FDA Approves First New Molecular Entity Under National Priority Voucher Program. Checked October 16, 2026.

Medicare GLP-1 Bridge

CMS tells pharmacies that eligible products, when used to reduce excess body weight and maintain weight reduction, are Foundayo, Wegovy (injection and tablets), and Zepbound KwikPen. The single-dose vial and single-dose pen formulations of Zepbound are not available through the Bridge. CMS says this list was updated on April 6, 2026 to include Foundayo after FDA approval and to limit Zepbound to the KwikPen. A fill is one monthly supply (28 or 30 days). Sixty- and ninety-day fills are not available. Pen needles for the KwikPen are not covered.

Stated April 6, 2026. CMS: Medicare GLP-1 Bridge: Information for Pharmacies. Checked October 16, 2026.

Medicare Part D

KFF’s brief, updated May 11, 2026, says CMS announced on April 21, 2026 — the day after the Part D sponsor application deadline — that it would not move forward with BALANCE in Medicare in 2027 and would extend the Bridge through the end of 2027. KFF says the original Medicare design ran from January 2027 through December 2031 and that implementation in Part D is now uncertain. KFF also describes cost sharing in that original Part D design: $245 for a 30-day supply in the deductible phase, then $50 per month for enhanced plans and employer group plans and $125 per month for basic plans, and $0 after the out-of-pocket maximum ($2,100 in 2026, $2,400 in 2027). Those Part D BALANCE copays are not a benefit CMS says is in effect for 2027.

Stated April 21, 2026. KFF: What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid and the Medicare GLP-1 Bridge. Checked October 16, 2026.

Medicare and Medicaid

The CMS BALANCE model page says state Medicaid agencies can join from May 2026 through January 1, 2027, and that eligible Part D beneficiaries have access through the separate Medicare GLP-1 Bridge from July 1, 2026 to December 31, 2027. CMS says the Bridge was extended through December 31, 2027 so the agency can collect GLP-1 utilization data to share with Part D sponsors ahead of potential BALANCE in Part D. CMS lists all formulations of Mounjaro, Ozempic, Rybelsus, and Wegovy, the KwikPen formulation of Zepbound, and Foundayo, for currently covered indications and for weight management. Participation is voluntary for manufacturers, state Medicaid agencies, and Part D plans. Coverage is not guaranteed for any individual.

Stated July 1, 2026. CMS: BALANCE Model. Checked October 16, 2026.

Medicare GLP-1 Bridge

On July 1, 2026, CMS announced that eligible people enrolled in Medicare Part D can obtain certain GLP-1 medications to lose weight or maintain weight reduction for $50 per month through December 31, 2027. CMS said people who already receive GLP-1 medications through existing Medicare prescription drug coverage, or who are eligible for GLP-1 coverage through the Part D benefit, will not qualify.

Stated July 1, 2026. CMS: CMS Launches Medicare GLP-1 Bridge, Expanding Access to GLP-1 Medications. Checked October 16, 2026.

Medicare GLP-1 Bridge

CMS describes the Medicare GLP-1 Bridge as a short-term demonstration for eligible Medicare Part D beneficiaries, running from July 1, 2026 through December 31, 2027. It operates outside the Part D benefit’s coverage and payment flow. Part D sponsors do not carry risk for these drugs and do not have to opt in.

Stated July 1, 2026. CMS: Medicare GLP-1 Bridge. Checked October 16, 2026.