Medicare Opens Doors to Weight Loss Drugs

A new Medicare pilot program, the Medicare GLP-1 Bridge program, is set to launch on July 1, potentially making popular weight-loss drugs accessible to millions of older adults. This program will offer coverage for GLP-1 medications such as Wegovy and Zepbound to eligible Medicare beneficiaries who meet specific height, weight, and other criteria. Participants will pay a $50 monthly copay, with Medicare covering the remaining cost.

This initiative marks a significant departure from Medicare's previous stance, as the federal health program for individuals aged 65 and older was prohibited from covering weight-loss medications. The bridge program is scheduled to run through the end of 2027, aiming to address the high cost of these drugs, which can exceed $1,000 per month and often face limited insurance coverage.

Eligibility for the Medicare GLP-1 Bridge program requires beneficiaries to have Part D prescription drug coverage and a prescription from a licensed prescriber. Qualifying individuals must meet certain body-mass index (BMI) requirements, generally a BMI of 35 or higher, or a BMI of 27 or higher with co-existing medical conditions like pre-diabetes or peripheral artery disease. Importantly, recipients already obtaining GLP-1s for conditions like Type 2 diabetes or heart disease risk will continue their current coverage and are not part of this specific bridge program.

Several GLP-1 medications are expected to be covered, including Novo Nordisk's Wegovy and Eli Lilly's Zepbound and Foundayo. This move comes as some employers are reportedly considering reducing coverage for these expensive drugs due to rising costs. While Medicare will handle approvals and claims for the bridge program, the private insurers administering Part D plans will not be directly involved.