WASHINGTON, March 10, 2026, 10:45 EDT
Eli Lilly said on Monday that a small number of basic Medicare Part D plans may not follow the widely advertised $50 monthly out-of-pocket cap for its weight-loss drugs, blunting one of the clearest promises in the federal government’s new obesity-drug coverage push. Lilly said most plan options should still honor the cap. 1
The timing matters because the U.S. Centers for Medicare and Medicaid Services has now laid out the Medicare GLP-1 Bridge, a short-term program that will run from July 1 through Dec. 31, 2026 and let eligible Part D members get Zepbound or Wegovy for obesity for a $50 copay before the broader BALANCE model starts in 2027. GLP-1 is the class of weight-loss and diabetes drugs now at the center of the fight over access and price. 2
Lilly said that when BALANCE reaches Medicare Part D on Jan. 1, 2027, its obesity drug Zepbound, diabetes drug Mounjaro and, if approved, oral candidate orforglipron will be available through participating plans, with most beneficiaries paying no more than $50 a month after the deductible is met. Before the deductible, the company said cost sharing would be limited to $245 plus a dispensing fee, though some basic plans may still vary. 3
That matters for Lilly because access, not just supply, is now the fight. The company last month forecast 2026 revenue of $80 billion to $83 billion, and CFO Lucas Montarce said price would be a drag on growth “in the low- to mid-teens” even as higher patient volumes help cushion the blow. 4
Lilly is also trying to add a pill to that playbook. Montarce said on March 2 the company was “on track in the US” for an orforglipron launch as early as the second quarter, pending Food and Drug Administration approval, and said Lilly could begin shipping about a week after a decision. 5
The company has been building other channels as well. Last week Lilly rolled out an employer-connect platform aimed at lower-cost obesity benefits and at steering workers toward FDA-approved treatments rather than compounded copies, the pharmacy-made versions that branded drugmakers have challenged. “By enabling coverage outside traditional benefit designs, we lower barriers to treatment,” Kevin Hern, senior vice president of Lilly Employer, said. 6
But the bridge is not a clean fix. Juliette Cubanski of KFF wrote on Monday that the program could offer “substantial benefits” to Medicare patients, yet the $50 copay will sit outside the normal Part D benefit, meaning it will not count toward a beneficiary’s deductible or the $2,100 annual out-of-pocket cap, and low-income subsidies cannot be used for those fills. She also said patients who start on the bridge may have to switch Part D plans in 2027 if their current plan does not join BALANCE. 7
Lilly shares were little changed in early New York trading on Tuesday, down about 0.6% by 10:30 a.m. EDT.
Novo Nordisk, Lilly’s main obesity rival, moved again on distribution this week by agreeing to sell Wegovy and Ozempic through Hims & Hers, while still holding the first oral obesity pill on the U.S. market. BTIG analyst David Larsen wrote that the tie-up reduced legal and regulatory risk for Hims, while BMO’s Evan David Seigerman said “one major issue has been resolved” for Novo. Even so, analysts said after Novo’s recent CagriSema stumble that taking share back from Lilly will be tough, leaving Medicare access and Lilly’s pending pill launch as the next tests of how durable its lead is. 8
