On November 6, the Trump Administration announced a plan to expand coverage and lower the price of anti-obesity medications (AOMs). Under the new agreement, drugmakers Eli Lilly and Novo Nordisk will offer versions of their AOMs at a discount for people through TrumpRx, a new government website that will sell medications at a discounted price. In addition, the President announced the deal with the manufacturers includes allowing Medicare beneficiaries and Medicaid beneficiaries – if their state Medicaid program allows it – to access AOMs for weight loss through a pilot program. According to the Administration, Medicare beneficiaries will pay a co-pay of $50 per month for these medications.
The Endocrine Society is pleased that efforts are now underway to allow Medicare beneficiaries to access AOMs for weight loss at an affordable price. The Society has long been an advocate for Medicare coverage of AOMs. In January, we urged the Trump Administration to finalize an earlier proposal offered by the Biden Administration to allow Medicare to cover AOMs for weight loss. We have also supported legislation, the Treat and Reduce Obesity Act (TROA), which would allow Medicare to cover AOMs for weight loss.
The announced price cuts vary and will come into effect no later than January for cash payers, by mid-2026 for Medicare patients, and on an ongoing basis for Medicaid enrollees depending on when states sign up, the White House said.
For currently available injectable GLP-1s used for diabetes and other covered health issues, prices to the government would fall to $245 per month for people with Medicare or Medicaid.
On the government's TrumpRx website, available to all Americans, the average price of injectables and pills will start at or below $350 a month and is expected to trend downward to $245 within two years.
We are currently seeking more details and information from the Administration and manufacturers as questions remain concerning what doses will be available and eligibility. This issue continues to be a top priority for the Society and we will continue to share additional information as we learn more.
On October 31, the Centers for Medicare and Medicaid Services (CMS) released the released the Medicare Physician Fee Schedule (MPFS) final rule for Calendar Year 2026. This annual rule updates payment policies and payment rates for Part B services furnished under the MPFS.
CMS estimates the final rule policies will result in a 3% increase in total Medicare charges for endocrinology. However, CMS finalized changes to the methodology for the allocation of indirect practice expense (PE) within the physician payment formula, which will decrease overall charges for endocrinology in the facility setting by -10% but increase payments by +6% in the non-facility (office) setting. In our comments to the agency, we urged CMS not to finalize the PE proposal noting that this would result in a decrease of indirect PE RVUs for our members regardless of their site of service.
The final rule also permanently adopted virtual coverage of direct supervision via real-time audio/visual and will allow teaching physicians to continue supervising residents virtually. Please note that while these telehealth policies have been finalized, there continues to be a lapse in Medicare telehealth waivers due to the ongoing government shutdown. We continue to urge Congress to pass a long-term telehealth fix which would ensure that patients can receive telehealth care from home. We encourage our U.S.-based members to join our online advocacy campaign to urge Congress to continue access to telehealth for Medicare beneficiaries.
The Society has posted a high-level summary of the policies in the rule that will affect endocrinologists here on our website. We are continuing to review the final rule and will provide a full analysis in the coming days.
On October 1, funding for the federal government expired because Congress failed to pass a continuing resolution (CR) to fund the federal government. As a result, there is currently a lapse in funding which will affect Endocrine Society researcher and clinician members. Members of Congress have remained gridlocked on how to reopen the federal government. This week, bipartisan Senate negotiations around reopening the government continued and Senate Majority Leader John Thune (R-SD) announced he planned to tee up a vote to end the shutdown on November 7. Meanwhile, Speaker of the House Mike Johnson (R-LA) warned his members not to leave the country as he may call them back to Washington early next week for a vote. It is expected that Senate Republicans will bring up the House-passed continuing resolution (CR) and then amend it to include a three-bill “minibus” consisting of full year funding bills for Military Construction-Veterans Affairs (MilCon-VA), Agriculture, and Comerce-Justice-Science and a likely revised CR that would go in into January. Further details of the deal between Democrats and Republicans and when the Congress may vote on a funding bill for the Department of Health and Human Services are not available. Below is information we hope will be helpful to you during the shutdown (we update this information weekly):
We urge you to join our online advocacy campaign to tell your Senators and Representative to pass a full-year funding bill that reopens the government and to support funding NIH at least at the Senate Appropriations Committee’s bill level of $47.8 billion for FY 26.
As a result of the current shutdown of the federal government, operations at the National Institutes of Health (NIH) have shifted to maintain essential services at its biomedical research hospital, the NIH Clinical Center. The Department of Health and Human Services (HHS) released a contingency plan that details which NIH activities will not resume during the shutdown. These activities include:
NIH staff, whose responsibilities are deemed necessary for patient care and the protection of property, will continue to work without pay.
Medicare and Medicaid Programs: According to the Centers for Medicare & Medicaid Services (CMS) contingency plan, during a lapse in funding, the Medicare Program will continue. CMS has sufficient funding for Medicaid to fund the first quarter of FY 2026, based on the advanced appropriation provided for in the Full-Year Continuing Appropriations and Extensions Act, 2025. CMS is maintaining the staff necessary to make payments to eligible states for the Children's Health Insurance Program (CHIP). CMS is also continuing Federal Marketplace activities, such as eligibility verification, using Federal Marketplace user fee carryover. Other non-discretionary activities including Health Care Fraud and Abuse Control (HCFAC) and Center for Medicare & Medicaid Innovation (CMMI) activities are also continuing.
Telehealth Services: Physicians who provide telehealth services to Medicare patients should be aware that the Medicare telehealth flexibility has lapsed for care to all patients except those being treated for mental health or substance use disorders. This means that telehealth services are limited to rural areas as they were before the COVID public health emergency and that patients cannot receive telehealth services in their homes. Note, however, physicians in certain Medicare Shared Savings Program accountable care organizations (ACOs) can continue to provide and be paid for telehealth services. In addition, the ability to provide audio-only services to Medicare patients lapsed, as did the Acute Hospital Care at Home program.
Special Diabetes Program & other health extenders: Funding for the Special Diabetes Program and other health extender programs has lapsed. Other programs include the community health centers, the National Health Service Corps, and teaching health centers that operate graduate medical education (GME) programs. It also includes public health emergency authorities (e.g., Public Health Emergency Fund); increased inpatient hospital payment adjustment for certain low-volume hospitals; Medicare-Dependent Hospital (MDH) program; quality measure endorsement, input, and selection; and outreach and assistance for low-income programs (e.g., area agencies on aging).
Medicare Claims: On October 22, CMS issued updated guidance instructing all Medicare Administrative Contractors (MACs) to lift the claims hold and process claims with dates of service of October 1, 2025, and later for certain services impacted by select expired Medicare legislative payment provisions. This includes claims paid under the Medicare Physician Fee Schedule, ground ambulance transport claims, and Federally Qualified Health Center (FQHC) claims. This includes telehealth claims that CMS can confirm are definitively for behavioral and mental health services. CMS has directed all MACs to continue to temporarily hold claims for other telehealth services (i.e. those that CMS cannot confirm are definitively for behavioral and mental health services) and for acute Hospital Care at Home claims. For the latest information, physicians should monitor their MAC’s website and this CMS webpage.
We rely on your voice to advocate for our policy priorities. Join us to show our strength as a community that cares about endocrinology. Contact your US representatives or European Members of Parliament through our online platform. Take action and make a difference today.
