Eli Lilly and Company announced that Medicare Part D plans will begin covering its leading obesity treatments on January 1, 2027.
The expansion follows new guidelines from the Centers for Medicare and Medicaid Services (CMS) under the CMMI BALANCE Model. The coverage applies to Zepbound, Mounjaro, and the experimental drug orforglipron upon its approval.
The new framework caps out-of-pocket expenses for Medicare beneficiaries. This policy significantly increases the potential patient pool for Lilly’s cardiometabolic franchise.
The company is currently working with CMS and private health plans to finalize access and affordability protocols for qualifying patients.