Key facts
- Medicare is offering a selection of GLP-1 weight loss drugs for $50 per month through the Medicare GLP-1 Bridge program.
- The program is a temporary trial set to run until the end of 2027.
- Eligibility requires a BMI of 35 or higher, or a BMI of 27 or higher with a qualifying health condition.
- Individuals already receiving GLP-1s for conditions like diabetes or sleep apnea are not eligible.
- Covered medications include Eli Lilly's Foundayo and Zepbound, and Novo Nordisk's Wegovy.
The federal government has launched a new trial program, Medicare GLP-1 Bridge, offering select GLP-1 weight loss medications for $50 per month to eligible Medicare beneficiaries. This initiative aims to make expensive weight-loss drugs more accessible to older Americans who meet specific health and body mass index (BMI) criteria.
The temporary program, which runs until the end of 2027, is the first time many older adults can get GLP-1s covered by insurance for weight loss purposes. To qualify, beneficiaries must have a BMI of 35 or higher, or a BMI of 27 or higher with an additional health condition such as a history of heart attack, stroke, or prediabetes. Those already receiving GLP-1s for conditions like diabetes or sleep apnea are not eligible for this specific program, though their existing Medicare Part D insurance may cover the drugs separately based on those diagnoses.
Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services (CMS), stated that the program's goal is to collect data that could inform future, longer-term coverage decisions, while providing immediate financial relief. He noted that the high cost of these medications has been a significant barrier to access.
The covered medications include Eli Lilly's Foundayo and Zepbound, and Novo Nordisk's Wegovy, all approved by the FDA for weight loss. For participants in the Bridge program, the $50 monthly cost does not contribute to their insurance deductibles or out-of-pocket maximums, as Medicare is subsidizing the prescription directly.
Longer-term coverage remains uncertain, as Congress has not yet authorized permanent Medicare coverage for weight loss drugs. The CMS will monitor participation and outcomes to determine the best path forward, which could include an extension of the Bridge program or another pilot initiative. Oz indicated that permanent coverage through a federal law is a matter for Congress to debate.
The GLP-1 drugs have gained significant popularity for their effectiveness in weight loss, but their high cost has been a barrier for many. For some, like 78-year-old Gloria Dralla, the program offers a chance to continue a life-improving treatment. However, others, like 71-year-old Katie Smith, express concern about meeting the eligibility requirements, highlighting the ongoing access challenges for some individuals.