Eli Lilly warns certain Medicare plans may surpass $50 limit for weight-loss medications

Eli Lilly has warned that some Medicare plans may not meet the $50 out-of-pocket cap for weight-loss medications. The update follows the Centers for Medicare and Medicaid Services (CMS) initiative to offer weight-management treatments, like Mounjaro and Zepbound, under Medicare Part D starting 2027.

On March 9, Eli Lilly issued a statement indicating that a limited number of standard Medicare prescription drug plans may not comply with the $50 monthly out-of-pocket limit for its weight-loss medications. This update is part of the U.S. Centers for Medicare and Medicaid Services (CMS) initiative focused on coverage for weight-loss treatments.

Medicare Coverage Model Background

Last year, CMS launched a voluntary program to include GLP-1 medications for weight management and diabetes care within both Medicaid and Medicare Part D plans. The program enables CMS to negotiate guaranteed net prices directly and set consistent coverage terms. Its objectives include capping out-of-pocket costs for patients and integrating these treatments with evidence-based lifestyle support services.

Out-of-Pocket Cost Details

CMS guidance specifies that eligible Medicare beneficiaries should pay $50 for a one-month supply of GLP-1 drugs, covering Eli Lilly's injectable medications such as Mounjaro and Zepbound. Eli Lilly clarified that while the majority of Medicare options will honor this $50 limit, a small subset of basic Medicare Part D plans may have varying cost-sharing amounts.

Availability of Eli Lilly Weight-Loss Medications

Starting January 1, 2027, Eli Lilly's weight-loss and diabetes treatments—including Zepbound, Mounjaro, and potentially Forglipron if approved—will be offered through participating Medicare Part D plans under this CMS coverage framework.

Patient Education and Support Programs

Eli Lilly emphasized its ongoing commitment to educating both patients and healthcare providers regarding Medicare plan options. The company also plans to implement support initiatives aimed at helping patients access GLP-1 medications while minimizing personal expenses.

About Medicare Part D

Medicare Part D is a federal program that assists Medicare enrollees with outpatient prescription drug costs. Coverage is provided through approved private insurance plans, which offer varying levels of benefits and cost-sharing arrangements for prescription medications.

Sources:

• Reuters
• Bloomberg
• The Wall Street Journal
• Eli Lilly says some Medicare plans may exceed $50 cap for weight-loss drugs

Author: Maya Henderson
Maya Henderson is a journalist focused on technology and startups. She has experience in leading IT publications and excels at conducting interviews and creating visual content.