The Trump Administration’s November 2025 announcement outlines a major proposal to reduce Medicare Part D prices for select GLP-1 medications to $245 per month and cap patient cost sharing at $50 per month. The proposal also signals a potential expansion of Medicare coverage beyond diabetes and cardiovascular disease to include obesity and related comorbidities. If implemented as early as 2026, these changes would substantially shift both the cost structure and utilization of GLP-1 therapies. The report summarizes what is known to date, highlights remaining regulatory questions, and explains how these changes intersect with prior Medicare drug price negotiation timelines.
Using an analysis of 2024 Part D plan data, 2026 bids, and a range of utilization and rebate scenarios, the paper finds that impacts on beneficiaries and plans will vary significantly. Most Part D members—those enrolled in copay-based benefit designs—may see no change or even higher annual cost sharing due to Part D adjudication rules, while members paying coinsurance would likely see savings. For plans, net liability could decline modestly or rise by several dollars PMPM depending on rebate levels, utilization growth from expanded access, and plan design. Given the uncertainty surrounding timing, eligibility criteria, and CMS implementation, plans should begin modeling potential impacts and preparing contingencies for 2026.
