Eli Lilly says some Medicare plans may exceed $50 cap for weight-loss drugs

March 9 (Reuters) - Eli Lilly LLY.N said on Monday a small number of basic Medicare drug plans may not follow the $50 per month cap on out-of-pocket costs for its weight-loss drugs, after the Medicare agency said it has completed negotiations with Lilly and Novo Nordisk for a new weight-loss drug coverage model.

• The U.S. Centers for Medicare and Medicaid Services on Monday said state Medicaid agencies and Medicare Part D plan sponsors can now apply to participate in the program that covers GLP-1 drugs for weight loss and diabetes.

• Under the model, the agency will set standardized coverage terms by directly negotiating guaranteed net prices, potentially capping out-of-pocket costs and bundling evidence-based lifestyle support.

• CMS said last year eligible Medicare beneficiaries will pay $50 for a month's supply of GLP-1 drugs, including Lilly's injectable Mounjaro and Zepbound.

• Lilly said on Monday that while the majority of Medicare plan options will honor the $50 out-of-pocket cap, cost-sharing will vary for beneficiaries in a small number of basic Medicare Part D plans.

• Beginning January 1, 2027, Lilly's Zepbound, Mounjaro and orforglipron, if approved, will be available through Medicare Part D participating plans under this program.

• Lilly said it will actively educate patients and their physicians about plan options as well as smoothing programs that can help patients access GLP-1 medications at the lowest possible out-of-pocket costs.

• Medicare Part D is the prescription drug benefit that helps Medicare enrollees pay for outpatient medications through approved private plans.