Federal Update: Trump Administration Announces Deal to Bring Most-Favored-Nation Pricing to GLP-1s

Trump Administration Announces Deal to Bring Most-Favored-Nation Pricing to GLP-1s

Overview:

Today, President Donald Trump announced a series of agreements with Eli Lilly and Company and Novo Nordisk to offer Most-Favored-Nation (MFN) prices on two GLP-1 therapies, semaglutide (brand names Ozempic and Wegovy) and tirzepatide (brand names Mounjaro and Zepbound). This marks the fourth and fifth publicly announced agreements between the Trump administration and pharmaceutical manufacturers, joining earlier announcements with Pfizer, AstraZeneca, and EMD Serono. The manufacturers also agreed to cap prices for insulin products and other commonly prescribed diabetes medications.

GLP-1s:

Direct-to-consumer arrangements: The manufacturers agreed to make existing GLP-1s indicated for chronic weight management available to consumers on the TrumpRx platform for an average monthly price of $350 for vials. These manufacturers sell most doses of Wegovy and Zepbound directly to eligible cash-paying patients via their own direct-to-consumer platforms for $499 per month, meaning the MFN price would represent a 30% discount. It is unclear whether the manufacturer would sell versions of their products with autoinjectors on the TrumpRx platform. If oral formulations of GLP-1s are approved by the US Food & Drug Administration for chronic weight management, the manufacturers agreed to price starting doses of these products at $150 per month.

During the press conference, Chris Klomp, Director of Medicare at the Centers for Medicare and Medicaid Services, stated that manufacturers have agreed to lower the price of injectable GLP-1s to the same level as the price offered to Medicare and Medicaid over the next 24 months.

Medicare and Medicaid: The manufacturers agreed to price injectable forms of Ozempic, Mounjaro, Wegovy, and Zepbound at $245 per month for Medicare. This price applies to all doses and indications. In exchange for these reduced prices, the Trump administration plans to enable Medicare coverage of Wegovy and Zepbound for patients with obesity and at least one comorbidity. Medicare beneficiaries will pay a $50 copay for AOMs. Medicare is statutorily prohibited from covering drugs for certain uses, including weight loss. The Biden administration proposed reinterpreting section 1927(d)(2) of the Social Security Act to enable coverage of anti-obesity medications (AOMs), but the Trump administration removed this proposal in the CY 2026 Policy and Technical Changes Final Rule.

The Trump administration announced that the $245 price would also be made available to state Medicaid programs for all covered doses. This announcement may influence more states to authorize coverage of GLP-1s for chronic weight management by offering reduced upfront costs for these products. Currently, 13 states cover GLP-1s for obesity according to KFF

Other Products on TrumpRx:

The Trump administration announced that Lilly and Novo had agreed to make other products commonly prescribed for diabetes available on the TrumpRx platform. While the fact sheet references discounts off the list price of certain products, it is unclear how these discounts compare to the net prices paid by Medicare, Medicaid, or commercial plans. Insured patients may receive a more favorable out-of-pocket price under their benefit’s copay or coinsurance.

• Eli Lilly will provide Emgality, a treatment for migraines, at $299 per pen, a discount of $443 off the list price.
• Eli Lilly will provide Trulicity, another GLP-1 medication commonly used to treat diabetes, at $389 per month, a discount of $598 off the list price.
• Novo Nordisk will provide widely-used insulin products, including NovoLog and Tresiba, at $35 per month of supply.

Additional Agreements:

In keeping with the Trump administration’s demands in letters to pharmaceutical manufacturers this summer, Lilly and Novo agreed to guarantee MFN prices on all new medications, repatriate increased foreign revenue on existing products, and make MFN prices available to all state Medicaid programs.

President Trump also touted investments announced by Eli Lilly and Novo Nordisk since he took office. Eli Lilly has announced $27 billion in investment commitments. Novo Nordisk has committed an additional $10 billion to expand its domestic manufacturing footprint, including the production of oral formulations of semaglutide in the United States.

Reactions:

In response to previous announcements on MFN pricing agreements with Pfizer and AstraZeneca, Senators Peter Welch (D-VT), Amy Klobuchar (D-MN), Ben Ray Lujan (D-NM), Elizabeth Warren (D-MA), Jeff Merkley (D-OR), Angela Alsobrooks (D-MD), and Bernie Sanders (I-VT) delivered a letter to HHS Secretary Robert F. Kennedy Jr. seeking additional details on the implementation of MFN agreements. The Trump administration has yet to provide guidance to state Medicaid programs in implementing MFN prices, nor have they announced the specific medications covered under each agreement. The administration has not provided details on the formula used in calculating MFN prices, nor have they listed the refence countries that will be used to determine the reference price.

The letter raises several concerns regarding the interaction of MFN prices with other existing pharmaceutical discount programs, such as 340B and the Medicare Drug Price Negotiation program. The Medicaid Drug Rebate Program (MDRP) already provides states, providers, and patients with statutorily required discounts on medications, while the MFN announcements are voluntary, negotiated on a manufacturer-by-manufacturer basis, and are not mandated by law. Georgetown University’s Center for Children and Families recently published a blog outlining theoretical challenges in reconciling MFN prices with the MDRP.

The letter also flags a potential conflict of interest between the Trump family and BlinkRx, a direct-to-consumer pharmaceutical purchasing platform which appointed Donald Trump Jr. to its Board of Directors in Feb. of this year. The Wall Street Journal previously reported that BlinkRx would be enlisted in actualizing the TrumpRx platform, but further details remain to be seen. The TrumpRx platform is set to launch in Jan. 2026.

Timeline:

May 12, 2025:

• President Trump signs Executive Order 14297, “Delivering Most-Favored Nation Prescription Drug Pricing to American Patients.” The Executive Order directs HHS to establish a most-favored-nation (MFN) price target that would apply to the prices charged to the Medicare and Medicaid programs.

July 31, 2025:

• The Trump administration delivers letters to 17 pharmaceutical manufacturers directing specific steps towards offering MFN prices to patients. This includes:
  • Extend the MFN price to every Medicaid patient.
  • Contract with the United States to guarantee that Medicare, Medicaid, and commercial payers receive the MFN price for newly launched drugs.
  • Participate in DTC or direct-to-business (DTB) distribution models for high-volume, high-rebate prescription drugs so all Americans get the same low MFN prices that manufacturers already offer to third-party payers.
  • Work with the US Trade Representative and Department of Commerce to repatriate increased foreign revenue in the form of lower drug prices for Americans.

Sept. 30, 2025

• President Trump and Pfizer announce the first voluntary agreement in response to the July 31 letters, in which Pfizer will offer its products at MFN prices in Medicaid, extend MFN prices to Medicare, Medicaid, and commercial payers for any new products launched in the U.S., and repatriate increased foreign revenue into lowering U.S. prices. Pfizer also agreed to offer its products at steep discounts to cash payers directly through the TrumpRx platform. Pfizer’s products will also be exempt from Section 232 pharmaceutical tariffs for three years, in response to the company’s commitment to invest an additional $70 million in U.S. research, development, and capital expenditures. Specific terms of the agreement remain confidential.

Oct. 10, 2025

• President Trump and AstraZeneca announce an agreement to offer AstraZeneca products at MFN prices in Medicaid, extend MFN prices to Medicare, Medicaid, and commercial payers for any new products launched in the U.S., and repatriate increased foreign revenue into lowering U.S. prices. AstraZeneca will participate in the TrumpRX DTC program and offer discounts to cash-paying patients of up to 80% on its products. AstraZeneca also committed an investment of $50 billion into U.S. manufacturing, research, and development by 2030, while AstraZeneca products are delayed from Section 232 tariffs for three years.

Oct. 16, 2025:

• President Trump announces an agreement with EMD Serono to offer the company’s three existing IVF therapies at MFN prices (roughly 84% discount) through the TrumpRx platform. EMD Serono’s other therapies are exempted from Section 232 pharmaceutical tariffs in return for increased domestic manufacturing capabilities. EMD Serono will also file a new IVF treatment, Pergoveris under the FDA Commissioner’s National Priority Voucher program.