Medicare Out-of-Pocket Costs Double for GLP-1s in 2025
Back in March 2024, we welcomed the news of a door opening ever so slightly for Medicare Part D plans to cover GLP-1s in people with obesity and heart disease. So 18 months later, it’s reasonable to ask, how’s that working out for everyone? A new research letter in JAMA gives us an answer, but it’s not very pretty.
In 2025, the administrative nightmare of prior authorization became nearly universal for Medicare beneficiaries who needed a GLP-1 for any reason. Adding insult to injury, out-of-pocket costs grew dramatically. For many people, the amount they pay is now twice as much for a GLP-1 as it was in 2023.
Data from 45 Million Medicare Members
Matthew Klebanoff and colleagues analyzed Part D formulary files for 2020 through 2025 to determine coverage, prior authorization requirements, and out-of-pocket costs. Four nifty graphs summarize their findings succinctly.
In 2025, coverage for Saxenda went down because its patent expired. It stayed low for Wegovy and Zepbound, despite new indications for heart disease and sleep apnea. Mounjaro coverage (for diabetes) went up to match Ozempic, which remained at high levels for formulary coverage. Where monthly out-of-pocket costs had been hovering at a bit more $50, they jumped up into the range of $150 in 2025.
The Growing Disconnect
The funny thing about this is that while Medicare drug plans are asking people to pay more if they need a GLP-1, the net cost of GLP-1s is going down rather dramatically. Ozempic, Wegovy, Mounjaro, and Zepbound all launched with monthly price tags that ranged up to $1,300. Now, they can be had for less than $500. The drop in net prices has been especially dramatic this year.
But the companies that run these drug plans are worried about utilization for these drugs going up because the medical need is so great. So raising the out-of-pocket costs to their customers while the prices they pay go down seems sensible in their world.
Shop Around
It’s worth noting that this nonsense has been a little less in Medicare Advantage plans. According to Klebanoff et al, these plans “can leverage Medicare Advantage rebates to offer lower cost sharing and may benefit financially from improved adherence to GLP-1s, given their liability for medical and pharmaceutical costs.”
The twisted economics of GLP-1 drug pricing and coverage mean two things for us. Shopping around for the best Medicare plan can be quite important. But also, many people are going to get a raw deal because of profiteering by pharma and the insurance industry.
This is not a marketplace that is functioning well.
Click here for the research letter in JAMA and here for further perspective.
Coins, illustration created with Gemini image generation
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September 28, 2025
