Will Medicare and Medicaid cover GLP-1s in 2026? What the New GLP-1 Price Cuts Mean for You.

GLP-1 medications like Ozempic®, Wegovy®, and Zepbound® are expected to become more affordable over the next few years, with expanded Medicare coverage starting in 2026. For many people living with obesity, prediabetes, or type 2 diabetes, this combination of lower prices and better coverage could be a game changer.

At JourneyMeds, our telemedicine team focuses on GLP-1 care and insurance navigation. If you want to know the moment GLP-1 coverage becomes available in your state or through your Medicare/Medicaid plan, you can join our insurance coverage watchlist anytime.

Yes, Medicare and Medicaid cover GLP-1s in 2026! Here's what the price cuts mean for you.

Recent federal policy—driven by agreements with major manufacturers—has initiated historic price reductions for obesity and diabetes medications. GLP-1 drugs that once cost $1,000+ per month are being repositioned with new pricing frameworks, including:

• Direct-to-consumer pricing portals

• Most-favored-nation pricing models

• Expanded Medicare & Medicaid coverage starting in 2026

• Manufacturing expansion commitments from companies like Eli Lilly and Novo Nordisk

For many patients, savings of up to 50% or more may become possible as these changes take effect.

What Price Cuts Are Coming in 2026 for GLP1's?

• TrumpRx (Wegovy, Zepbound): $350/month (direct buyers).

• LillyDirect (Zepbound pens): currently about $299–$449/month for self-pay.

• Medicare pricing: $245/month reference price — eligible patients may pay as little as $50/month out-of-pocket.

• Oral GLP-1s via Medicare/Medicaid/TrumpRx: $145/month (expected 2025–2026, pending approval).

JourneyMeds option: If you’d prefer to start treatment now, JourneyMeds currently offers GLP-1 starter plans for $259/month — a meaningful saving compared with the $350 TrumpRx starter price. Learn more on our homepage or join our insurance coverage watchlist to get personal updates and help switching to new coverage when it becomes available.

Program	Whats New	Who Qualifies	Starting Price	Start Time
Medicare (Part D pilot)	First‑ever coverage for obesity meds; capped copays	~10% of beneficiaries (BMI + comorbidity criteria)	$50/month copay* / Reference price: $245/month	Mid‑2026
TrumpRx (DTC portal)	Direct‑buy brand GLP‑1s at negotiated pricing	Anyone (largest discounts likely with Medicare/Medicaid)	$350/month to start	Early- Mid  2026
Oral GLP‑1 pills (pending approval)	Upcoming oral options for weight management	Medicare / Medicaid / TrumpRx users	$145/month	Late 2025–2026
Medicaid (state‑by‑state)	States opt in to get discounted pricing	State Medicaid beneficiaries	Varies (aligned to negotiated prices)	2026 onward

What Are GLP-1 Medications?

GLP-1 agonists—such as Ozempic®, Wegovy®, Zepbound®, Mounjaro®, and Trulicity®—are groundbreaking medications that:

• Improve blood sugar regulation

• Suppress appetite and slow digestion

• Support 5–20%+ body weight reduction

• Reduce cardiovascular risk

These medications have become central to the fight against the obesity epidemic, impacting over 42% of U.S. adults, and the 37 million Americans living with diabetes.

At JourneyMeds, patients are evaluated through a seamless telemedicine intake, and prescribed GLP-1 therapy when appropriate. We also advise patients on insurance changes—including the big Medicare reforms coming in 2026.

To get notified when Medicare or Medicaid in your state begins covering GLP-1 therapy, join our insurance coverage watchlist!

How GLP-1s Support Weight Loss & Diabetes Management

GLP-1 medications mimic a naturally occurring hormone that:

• Regulates insulin

• Reduces glucagon

• Slows gastric emptying

• Enhances satiety

Clinical benefits include:

• 15–20%+ weight loss in obesity-dosing ranges (Wegovy®, Zepbound®)

• 5–10% weight loss in diabetes-dosing ranges

• A 26% reduction in major cardiovascular events for certain high-risk patients

These medications are even more effective when paired with lifestyle support—something JourneyMeds providers help patients integrate into their care plans.

How Medicare Coverage Will Change in 2026?

Medicare’s planned expansion in 2026 could be the single biggest change yet for GLP-1 access.

Key changes (starting mid-2026):

• First-ever Medicare Part D coverage for obesity treatment.

• Copays as low as ~$50/month for qualifying patients.

• Medicare’s negotiated reference price: roughly $245/month.

• Millions of beneficiaries are expected to become newly eligible.

• State Medicaid programs may opt in to similar pricing on a state-by-state basis.

Who’s likely to qualify:

• BMI ≥ 27 plus conditions such as prediabetes or cardiovascular disease.

• BMI ≥ 30 with comorbidities like uncontrolled hypertension, kidney disease, or heart failure.

• BMI ≥ 35, even without additional conditions.

  
  

Current estimates suggest roughly 10% of Medicare beneficiaries may meet the rules and qualify under the pilot.

Note: Coverage details will vary by plan and by state. JourneyMeds monitors these changes in real time and helps patients understand whether they’ll qualify and how to prepare.

If you want a heads-up when Medicare or your state Medicaid plan adds GLP-1 coverage, join the JourneyMeds Insurance Coverage Watchlist. For more about our telemedicine GLP-1 program, visit JourneyMeds.

Who benefits most from these price cuts?

Likely winners:

• Older adults on Medicare who have obesity or metabolic comorbidities.

• Medicaid enrollees in states that opt in to the new pricing.

• Self-pay patients who want more predictable monthly costs.

• People with commercial insurance as plan sponsors and payers adjust to lower market prices.

• Patients managing diabetes, hypertension, or cardiovascular risk who can gain both clinical and financial benefit.

Who may not benefit right away:

• People whose BMI or medical history doesn’t meet the coverage rules.

• Residents of states that delay Medicaid participation.

• Members of plans that decline to adopt the 2026 GLP-1 coverage policies.

At JourneyMeds, we help patients determine likely eligibility, prepare documentation, and connect with clinicians via telemedicine. If you want targeted updates for your situation (state, insurance type, or specific drug), join our Insurance Coverage Watchlist or learn more about our program on the JourneyMeds homepage.

Access for non-Medicare patients

Price reforms will ripple through commercial and self-pay markets, creating different pathways to access GLP-1 therapy.

Commercial insurance

Many insurers are expected to expand GLP-1 benefits or reduce copays; in some plans copays could fall to around $25/month for eligible members. Employer-sponsored plans and wellness programs may also begin to subsidize GLP-1 treatment more aggressively as overall prices come down.

Self-pay & immediate access

Direct-purchase discounts, manufacturer rebates, and clearer monthly pricing tiers will make GLP-1s more affordable for people paying out of pocket. At JourneyMeds, we also offer self-pay starter plans today so patients who want to begin therapy don’t have to wait for plan changes. We accept FSA/HSA and provide straightforward monthly pricing and payment options for fast access to telemedicine evaluations and prescriptions. Learn more or start now at JourneyMeds.

Employer & plan initiatives

Some employers are likely to add GLP-1 coverage into wellness benefits to reduce long-term chronic-disease costs for their workforce. If your employer is considering a program, JourneyMeds can help design or connect to clinical pathways that fit employer wellness goals.

How JourneyMeds helps non-Medicare patients

We work with commercially insured and self-pay patients to estimate out-of-pocket costs, identify manufacturer savings programs, and decide whether a cash or insured route makes the most sense in the short term. We’ll also help with prior authorization and documentation if you want to pursue insurance coverage. For tailored alerts about commercial plan changes or self-pay pricing, join our insurance coverage watchlist or visit our home page  to get started.

Final thoughts — start now or prepare to switch later

The next 18–24 months will likely reshape GLP-1 access and pricing, but you don’t have to wait to take action. If you want immediate access to treatment, take the 60-second quiz and choose the self-pay pathway — JourneyMeds accepts FSA/HSA and can get you evaluated and started quickly. If you prefer to use insurance, join our watchlist and we’ll alert you the moment your plan or state adds coverage so you can switch with minimal friction.

• Start instantly → Take the JourneyMeds quiz

• Stay informed → Join the Insurance Coverage Watchlist

• Learn more about our program →Visit JourneyMeds