A historic new deal slashes drug prices and opens the door to federal coverage, but advocates warn disparities may widen before they shrink.

When federal officials announced earlier this month that Medicare could begin covering GLP-1 medications for obesity as early as next spring, the news landed like a lifeline for millions of older adults who have spent years battling both chronic disease and the high cost of treatment.

The White House’s November 2025 announcement — reached through agreements with Eli Lilly and Novo Nordisk — marks the first time Medicare has ever opened a dedicated pathway to cover GLP-1 medications for obesity. Until now, Medicare could only cover these drugs under narrow, non-obesity indications such as diabetes, sleep apnea, or cardiovascular disease.

Under the new pricing deal, Medicare will be able to purchase GLP-1 drugs at approximately $245 per month, and beneficiaries in participating plans will pay no more than $50 per month out of pocket.

If implemented on schedule, coverage could begin as early as April 1, 2026, according to Eli Lilly’s public statement.

But the announcement is not a guarantee of universal access — and that’s where advocates say the story becomes more complicated.

Two Medicare Demonstrations — One in 2026, One in 2027

To accelerate availability, Medicare will rely on two demonstration projects, confirmed by public briefings and advocacy organizations:

1. A 2026 demonstration (using CMS’s existing demo authority)

• Expected to begin as early as April 2026.
  
• Allows Medicare Part D and Medicare Advantage plans to begin offering GLP-1 coverage sooner rather than waiting for the next plan-year cycle.
  
• Participation by plans is voluntary, meaning availability will vary widely.

2. A larger CMMI demonstration starting in 2027

• Launches January 1, 2027.
  
• Participating plans will incorporate GLP-1 coverage into their formal bids.
  
• Retains the $50 copay and $245 negotiated price.

These demonstrations reflect a major shift in federal policy — one that health advocates have pushed for over a decade.

Medicaid: Opportunity Without Guarantees

While Medicare’s path forward is clearer than ever, Medicaid remains fractured. Under the deal, states may purchase GLP-1 medications at the same $245 monthly price, but coverage decisions remain entirely optional and determined state by state.

This means:

• Some states may expand coverage.
  
• Others may maintain strict limits.
  
• Still others may choose not to cover GLP-1s for obesity at all.

Advocates fear that unless states opt in, the people already facing the highest burden of obesity-related chronic disease — low-income individuals, people of color, and rural communities — may continue to be left behind. 

Patients Are Hopeful — But Cautious

For many Medicare beneficiaries, the announcement represents a potentially transformative shift in access to obesity treatment. Early reactions from advocacy groups indicate a mix of optimism and uncertainty, as individuals wait to learn whether their specific Medicare Advantage or Part D plans will participate in the new demonstrations.

Because insurers must opt in, analysts note that availability may differ widely across plans and regions. They also warn that:

• Some insurers may decline to participate in 2026 due to administrative or logistical challenges.
  
• Coverage is likely to remain inconsistent until 2027, when the larger CMMI model launches.
  
• Some beneficiaries may need to change plans to gain access to GLP-1 medications.

A Turning Point After Months of Scrutiny

The administration’s announcement follows months of heightened attention on GLP-1 access and affordability — including congressional hearings, inspector-general reviews, and bipartisan calls to address drug pricing pressures. Policymakers and researchers have emphasized the long-term health benefits associated with GLP-1 therapies, particularly regarding diabetes prevention and cardiovascular risk reduction, alongside the downstream costs of untreated obesity.

Experts say the Medicare decision reflects a growing recognition of obesity as a chronic, biologically driven disease rather than a lifestyle issue. Many stress, however, that the real test will be in execution: whether plan participation, state decisions, and implementation timelines allow the policy to reduce disparities rather than reinforce them.

What Happens Next

Official CMS guidance is expected early in 2026. Until then, beneficiaries and providers will be watching closely.

Advocates recommend that patients:

• Review their plan materials as insurers announce whether they will participate.
  
• Work with providers to document obesity-related conditions for eligibility.
  
• Share personal stories with advocacy organizations pushing states and insurers to opt in.
  
• Track Medicaid decisions in their state as legislatures begin 2026 sessions.
  

Why This Moment Matters

For the first time, Medicare is preparing to treat obesity the way medicine now understands it: as a chronic, relapsing, biologically driven disease. Whether this policy expands access equitably — or reinforces existing disparities — will depend on choices made over the next several months by health plans, states, and federal regulators. For now, patients are left with something rare in the obesity-care landscape: the possibility of real, sustainable access.