RISE summarizes recent regulatory-related headlines and reports.
Medicare to cover weight-loss drugs at reduced price
President Donald Trump on Thursday announced an agreement with pharmaceutical manufacturers Eli Lilly and Company and Novo Nordisk to dramatically reduce the price of popular weight-loss drugs.
As part of the administration’s efforts to lower drug prices, Medicare will pay $245 for Ozempic, Wegovy, Mounjaro, and Zepbound and eligible Medicare beneficiaries will only have a $50 copay for Wegovy and Zepbound approved for both obesity and diabetes.
The American Medical Association (AMA) praised the news. “Expanding access to effective therapies such as GLP-1 medications represents a significant step forward in confronting an obesity epidemic that now affects more than 40 percent of adults in the United States,” said Bobby Mukkamala, M.D., president of the AMA.
New payment model to lower drug prices in Medicaid
The Centers for Medicare & Medicaid Services (CMS) on Thursday also announced a new payment model to lower prescription drug spending in Medicaid.
State Medicaid programs that choose to participate in the GENErating cost Reductions fOr U.S. Medicaid (GENEROUS) Model can purchase drugs included in the pilot at lower prices that align with those paid in other countries.
The new model, which will launch in 2026, allows CMS to negotiate with participating manufacturers for lower prices, while states adopting the model will implement uniform, transparent coverage criteria. CMS Innovation Center Director Abe Suttons aid the model is meant to ensure that Medicaid pricing is on par with those in other developed nations.
All 50 states have applied for share of $50B rural health transformation program
Every state is interested in funding to strengthen health care across rural America, according to CMS.
The new Rural Health Transformation Program invited every state to design a plan for transforming its rural health care system. Each proposal had to explain how states intend to expand access, enhance quality, and improve outcomes for patients through sustainable, state-driven innovation.
The program provides $50 billion in funding to approved states over five years.
“Seeing all 50 states come forward to reimagine the future of rural health is an extraordinary moment, said CMS Administrator Dr. Mehmet Oz in the announcement. “This program moves us from a system that has too often failed rural America to one built on dignity, prevention, and sustainability. Every state with an approved application will receive funding so it can design what works best for its communities—and CMS will be there providing support every step of the way.”
CMS will now review all applications and announce approved awardees by December 31, 2025. States that are approved will receive baseline funding—representing 50 percent of total available program funds—that is distributed equally. Funding will be distributed over five years.