By Joe Nadglowski, President and Chief Executive Officer

Reflections on a Big Week for Obesity Care

The first week of November was quite the whirlwind for the OAC team! We knew it was going to be a busy one, with half of our staff, myself included, in Atlanta for ObesityWeek, The Obesity Society’s annual meeting. Throughout the week, we had more than two dozen partner meetings, presented multiple posters highlighting our lived experience research, participated in numerous sessions featuring OAC staff and volunteers as speakers and staffed an incredibly busy exhibit booth. We also hosted our annual mixer celebrating those who make OAC’s work possible and attended more side events, receptions, breakfasts, lunches and dinners than I can count.

As always at ObesityWeek, our days started early and ended late, but it was worth every minute to connect with so many dedicated volunteers, supporters, and friends — both old and new.

Big News from Washington, DC

While we were busy with all our activities at ObesityWeek, a big announcement came from Washington, DC, President Trump, his Cabinet, and the CEOs of Novo Nordisk and Eli Lilly announced new Medicare coverage for obesity medications, potential Medicaid coverage, and reduced pricing for both the current and upcoming classes of GLP-1 medications.

Here’s What was Announced

Medicare Coverage: Beginning April 2026, Medicare will cover obesity medications for individuals meeting certain body mass index (BMI) and co-complication criteria through a demonstration project (technically two demonstration projects — one under Section 402 and another through the Center for Medicare and Medicaid Innovation (CMMI) starting January 1, 2027). These two phases were structured this way for technical reasons, allowing the demonstration to launch sooner.

  • Co-pay: $50 for Medicare recipients
  • Cost to CMS: $245 per medication
  • Opt-in required: Both Part D and Medicare Advantage plans will need to opt-in, so coverage may vary by plan.

State and Medicaid Options: States will have the option to access the $245 price as well, which increases the likelihood that Medicaid programs will participate.

Pricing Changes: The announcement also included new direct-to-consumer pricing initiatives. Current GLP-1 medications (with start date anticipated January 1, 2026) and future oral GLP-1 medicines — expected as early as next year — will have reduced costs for patients purchasing through the soon-to-be-created TrumpRx aggregator, or through LillyDirect and NovoCares programs. While full pricing details weren’t released, average cost of the medicines was estimated around $350 per month with initial starting doses of future oral drugs (if approved) starting around $150 per month (larger doses priced at higher amounts).

It’s important to note that these announcements do not directly affect private or employer-sponsored insurance coverage. However, Medicare decisions often set the precedent — so this move could strongly influence future private coverage.

A Moment of Reflection

Since the announcement, I’ve received countless congratulatory messages (thank you!), along with one recurring question: How are you feeling?

Honestly, I’ve been reflecting quite a bit on our efforts to improve access under Medicare. It’s been a long journey — from those early, lonely days more than a decade ago when it was just OAC’s policy consultant Chris Gallagher and me walking the halls of Capitol Hill, to now, when thousands of patients, families, and healthcare professionals have joined us in this movement for better obesity care.

Throughout the years, we’ve seen progress come in starts and stops, but this moment feels different. It’s a major milestone — not only because it opens the door to Medicare coverage, but because what Medicare does, private insurers often follow. This gives us a powerful opportunity to reset and improve the national conversation around obesity care and coverage.

Frankly, we were preparing to spend much of next year playing defense, protecting coverage at the state level especially in Medicaid. Now, with this new momentum and transparent pricing ($245 under Medicaid), we can go on offense — building coverage and care access instead of just defending it.

The Work is Far from Over

Does this mean we’re done? Absolutely not.

We still need to pass the Treat and Reduce Obesity Act (TROA). Demonstration projects are just that — temporary — and can end at any time. Passing TROA will cement long-term coverage in law and ensure stability for Medicare recipients affected by obesity.

We’ll also need to:

  • Push Medicare Part D and Advantage plans to opt in and design fair benefits.
  • Encourage state Medicaid programs to participate.
  • Continue engaging private insurers and employers to expand coverage.

The door to obesity care coverage has started to open — now it’s our job to push it all the way open.

A Grateful Heart and a Renewed Mission

To the thousands of patients, family members, healthcare professionals, partner organizations, industry partners, and friends who’ve stood with us — thank you.

Your persistence and passion made this possible. But this isn’t the time to rest — it’s time to double down. Together, we’ll keep advocating until every person who needs obesity care has access to it. Help us continue our mission by donating to the OAC Action Fund.