What Trump's GLP-1 weight-loss drug deal means for Long Island consumers

The Trump administration’s recent deal with drug manufacturers to lower the cost of popular GLP-1 weight-loss medications is a "game-changer," but the price for many Americans would still be too high to afford, Long Island obesity doctors said.

"This is going to alleviate a lot of pressure and anxiety" for those now able to afford the drugs, said Dr. Eileen Barr, an obesity physician in East Setauket.

But the discounts in some cases will be modest: Drugmaker Eli Lilly agreed to charge $449 a month for a new, yet-to-be-government-approved version of Zepbound.

The current price of Zepbound when purchased directly from the company is $499; it can be more than $1,000 when bought through pharmacies. The lowest dose will cost $299 a month. Novo Nordisk, which makes Wegovy, has not announced its prices.

Higher doses, however, generally are needed to help people lose significant weight, said Dr. Andrea Bedrosian, director of bariatrics at North Shore University Hospital in Manhasset.

GLP-1s currently are taken in injections, but Eli Lilly is asking for Food and Drug Administration approval for a pill, orforglipron, that it has agreed to price at $149 for the lowest dose, and $399 for other doses.

"That is still a very high price to ask," said Dr. Konstantinos Spaniolas, director of the Stony Brook Bariatric and Metabolic Weight Loss Center.

Even so, he said, combined with a planned $50 monthly Medicare copay for some GLP-1s that would cover many but not all Medicare beneficiaries with obesity, and possible Medicaid coverage, the deal "is a great step in the right direction to allow patients to get the care they need."

Medicare, a federal program for people 65 and over and younger people with certain disabilities, currently does not cover GLP-1s for weight loss, nor does Medicaid in most states, including New York. They do cover them for diabetes.

Uncertain impact for Medicaid

Medicaid is a state-federal program for low-income people. The agreement allows state Medicaid programs to purchase the drugs for $245, the White House said. States decide whether to cover the drug.

New York "is still in the process of reviewing the announcement of the Trump administration," the state Health Department said in an email.

Low-income residents have the highest obesity rates, state data shows.

"If we make this affordable for them, it will be a huge benefit," said Dr. Venkatesh Sasthakonar, director of bariatric surgery at Nassau University Medical Center in East Meadow.

Medicaid patients wouldn’t be able to afford several hundred dollars a month, he said.

"They are more worried about food, rent, transportation," he said.

GLP-1 drugs when used for diabetes currently are free or at a small copay when purchased through a federal program for patients of "safety-net" health care facilities like Harmony Healthcare, which operates nine nonprofit health centers in Nassau, said David Nemiroff, president and CEO of Harmony. It’s unclear if GLP-1s when used for weight loss will be added to the program, he said.

Scaling back over costs

The Nov. 6 announcement of the GLP-1 deal came as some companies consider cutting the drugs from insurance plans. Most companies have never covered the medications for weight loss, surveys show, but many that did now plan to scale back or eliminate coverage because of their high price and popularity, the health-policy nonprofit KFF found in its annual survey of employer health care costs.

Tens of millions of Americans have used GLP-1 or a similar drug — more than 12% of the population, according to a Gallup Poll released Oct. 28.

More than 29% of New York’s population had obesity in 2021, state health data shows. Suffolk has a similar rate to the state’s; Nassau’s rate was 24.9%.

GLP-1s are for far more than aesthetics, Bedrosian said. Obesity is linked to many health problems, including heart disease related to high blood pressure, Type 2 diabetes, orthopedic issues, joint pain and reduced mobility, she said.

Spaniolas said some patients never have used GLP-1s because of the price. Others stopped taking the drugs after insurance companies eliminated coverage, or after they paid the $499 direct-to-consumer price for a few months.

"They think, ‘Once I lose the weight, I'm going to stop, and the cost is going to go away,’ but then the weight comes back," he said. "It's really a long-term, one could say lifelong, condition that requires lifelong management."

Some people try to take the drug less often than the regular weekly injection to save money, Bedrosian said, with mixed results.

Jessica Baylis, 45, takes Zepbound every few weeks after losing nearly 40 pounds on GLP-1s. The Greenlawn woman initially lowered the frequency of injections for financial reasons, but she’s found that the appetite suppression stimulated by GLP-1s works for four to five weeks before she needs a new dose.

Baylis said losing 40 pounds has given her more energy and makes her feel healthier.

"It’s been a miracle," she said. "It literally is life-changing."

By David Olson

david.olson@newsday.com@DavidOlson11

David Olson covers health care. He has worked at Newsday since 2015 and previously covered immigration, multicultural issues and religion at The Press-Enterprise in Southern California.