The administration recently announced a new initiative aimed at lowering the cost of glucagon-like peptide-1 (GLP-1) medications for certain Medicare beneficiaries. The policy marks a shift from earlier positions that excluded anti-obesity drugs from Medicare and Medicaid coverage. For health system leaders, clinicians, and Medicare administrators, the announcement raises important questions about access, pricing stability, and the future role of telehealth in obesity care.
Historically, Medicare excluded drugs prescribed solely for weight loss, weight gain, or appetite suppression, which has shaped the current market. While the proposed contract year 2026 Medicare Advantage and Part D rule initially included language that would have expanded coverage for weight loss medications, those provisions were removed from the final rule. As a result, beneficiaries with obesity and related conditions have continued to face limited coverage options.
Telehealth companies quickly filled that gap by offering GLP-1 medications through subscription pricing, cash-pay models, or compounded formulations. This appealed to patients who lacked coverage and were priced out of branded products that often exceeded $1,000 per month.
The administration’s new plan will likely change that landscape. On November 6, 2025, federal officials announced agreements with manufacturers of branded GLP-1 medications that significantly reduce prices under a new direct-to-consumer platform known as TrumpRx. Beginning in April 2026, Medicare will also cover GLP-1 medications for beneficiaries with obesity and qualifying comorbidities.
Because Medicare coverage rules have not been formally amended, CMS plans to rely on two demonstration authorities to implement this expansion. These include a Section 402 Part D demonstration and a Center for Medicare and Medicaid Innovation demonstration. CMS has used similar tools in the past to test premium stabilization, drug vouchers, and reduced cost sharing for generics without changing statutory coverage rules.
Under the announced framework, Medicare pricing for injectable GLP-1 medications will be set at approximately $245 per month, with beneficiary copays capped at $50. State Medicaid programs will also have access to these pricing arrangements. TrumpRx will offer GLP-1 injections for roughly $350 per month, primarily targeting cash-pay patients and bypassing intermediaries such as pharmacy benefit managers by connecting patients directly with manufacturer programs.
The plan also includes incentives for manufacturers developing oral GLP-1 products. The first oral GLP-1 pill received FDA approval on December 22, 2025 with introductory pricing of $149 per month for the lowest dose.
What This Means for North Carolina Beneficiaries
For Medicare beneficiaries in North Carolina, the impact could be significant. The state has a high prevalence of obesity, diabetes, and cardiovascular disease, particularly in rural and underserved areas. Many beneficiaries currently rely on out-of-pocket payment or forego treatment altogether due to cost.
With copays capped at $50 under Medicare and lower cash-pay options through TrumpRx, more North Carolina beneficiaries may seek GLP-1 therapy through primary care practices rather than telehealth-only channels. This could increase demand within Medicare Advantage plans operating in the state and place new emphasis on care coordination, prior authorization workflows, and provider education.
North Carolina’s Medicaid program is also expected to benefit from access to these pricing arrangements, which may improve continuity of care for beneficiaries who transition between Medicaid and Medicare coverage. Providers serving dual-eligible populations should prepare for increased utilization and questions around eligibility and documentation of comorbidities.
Market and Compliance Considerations
Despite the affordability gains, uncertainty remains. CMS has already announced negotiated prices under the Medicare Drug Price Negotiation Program that take effect in 2027. Those prices are higher than some TrumpRx offerings. Part D plans must use negotiated prices, while most-favored-nation pricing remains optional, creating potential confusion when the programs overlap.
Telehealth providers may see their pricing advantage narrow, and regulatory scrutiny is increasing. The FDA issued warning letters in September 2025 related to GLP-1 distribution practices. Providers and digital health companies should reassess marketing, supply chains, and pricing strategies to remain compliant.
Looking ahead, Medicare’s evolving approach to GLP-1 coverage is likely to reshape access and competition across the obesity treatment market. Health systems and clinicians should evaluate how these changes affect patient demand, prescribing patterns, and care coordination, while remaining alert to further guidance from CMS and the FDA as demonstration models unfold.