WASHINGTON, March 10, 2026, 10:45 EDT
Eli Lilly said Monday that some basic Medicare Part D plans could end up charging more than the touted $50 monthly out-of-pocket cap for its weight-loss drugs—a hitch in what had been one of the Biden administration’s marquee pledges around new obesity-drug coverage. Most plan options, according to Lilly, should still stick to the cap.
Timing is key here: The U.S. Centers for Medicare and Medicaid Services has set out details for the Medicare GLP-1 Bridge, a temporary plan running from July 1 through Dec. 31, 2026. It will allow eligible Part D enrollees to access Zepbound or Wegovy for obesity with a $50 copay, before the wider BALANCE model comes online in 2027. GLP-1 drugs sit at the heart of the current battle over pricing and access for weight-loss and diabetes treatments.
Lilly said when BALANCE enters Medicare Part D on Jan. 1, 2027, Zepbound and Mounjaro—its obesity and diabetes drugs—plus orforglipron, assuming approval, will be offered under participating plans. Most enrollees would see monthly costs capped at $50 after the deductible. Prior to meeting that deductible, cost sharing tops out at $245 plus a dispensing fee, though some basic plans could differ.
Lilly’s challenge has shifted: it’s about access now, not just supply. Last month, the company projected 2026 revenue between $80 billion and $83 billion. CFO Lucas Montarce cautioned that price will hold back growth “in the low- to mid-teens,” though more patients using its drugs should soften the impact. Reuters
Lilly’s aiming to expand its lineup with a pill as well. On March 2, Montarce told reporters the company was “on track in the US” to launch orforglipron as soon as the second quarter, assuming the Food and Drug Administration gives the green light. Lilly could start shipping just a week after the FDA decision. Reuters
The company’s outreach isn’t stopping there. Just last week, Lilly launched an employer-connect platform targeting more affordable obesity benefits and directing employees to FDA-approved therapies—not compounded versions, which branded drugmakers have pushed back against. “By enabling coverage outside traditional benefit designs, we lower barriers to treatment,” said Kevin Hern, senior vice president of Lilly Employer. Reuters
The bridge isn’t a straightforward solution. Juliette Cubanski at KFF, writing Monday, pointed out that while the program might deliver “substantial benefits” for Medicare patients, the $50 copay falls outside standard Part D coverage. That means it won’t apply to a beneficiary’s deductible or the $2,100 annual out-of-pocket limit—plus, low-income subsidies can’t be used on those fills. Cubanski also flagged another issue: patients who start on the bridge could be forced to switch Part D plans in 2027 if their current plan skips BALANCE. KFF
Lilly slipped roughly 0.6% by 10:30 a.m. EDT, with shares barely moving in early New York action on Tuesday.
Novo Nordisk, Lilly’s main obesity competitor, took another step in distribution this week, locking in a deal to supply Wegovy and Ozempic via Hims & Hers, and still keeps its position as the only company with an oral obesity pill on the U.S. market. BTIG’s David Larsen flagged that this partnership lowers legal and regulatory risk for Hims. BMO’s Evan David Seigerman put it simply: “one major issue has been resolved” for Novo. But following Novo’s recent CagriSema setback, analysts point out that clawing market share from Lilly won’t come easy. The spotlight now shifts to Medicare access and Lilly’s expected obesity pill launch—key moments that will test just how strong Lilly’s advantage is. Reuters
