GLP-1s are about to get more affordable for millions of Americans with Medicare.
The Centers for Medicare & Medicaid Services is launching the Medicare GLP-1 Bridge, a short-term demonstration program that will expand access to certain weight-loss drugs for seniors and other Medicare beneficiaries. Participants will pay $50 per month for a covered GLP-1 drug, such as Wegovy or Zepbound.
The pilot program begins July 1 and runs through Dec. 31, 2027.
“GLP-1s can be life-changing for patients managing obesity and related conditions,” said Chris Klomp, director of Medicare and chief counselor at the U.S. Department of Health and Human Services, in the program announcement.
“This demonstration is designed to make accessing those medications simpler, more predictable, and more consistent across the Medicare program, which means better quality of life for seniors and better value across the health care system.”
What is the Medicare GLP-1 Bridge program?
Medicare currently does not cover drugs prescribed only for weight loss. Until now, GLP-1s were eligible for Medicare coverage only when prescribed for conditions such as type 2 diabetes and cardiovascular disease.
The Medicare GLP-1 Bridge program is designed to provide temporary access to certain GLP-1 drugs for weight loss. Based on 2023 data, health policy research organization KFF estimates that 3.8 million Medicare beneficiaries may be eligible. Klomp recently estimated there would be “single-digit millions” of eligible beneficiaries, though he expects that number to grow over time.
The program operates outside standard Medicare Part D coverage and payments, so the $50 copay will not count toward yearly plan deductibles or out-of-pocket limits. It also won’t qualify for the Medicare Prescription Payment Plan or subsidies for beneficiaries with low incomes.
Everyone will pay $50 per month for the drugs throughout the program.
Which GLP-1 drugs are eligible?
Not all GLP-1s are eligible for the GLP-1 Bridge program. Right now, the list is limited to three drugs in specific formulations:
GLP-1 savings
For eligible Medicare beneficiaries, a $50 monthly copay is far below current prices for GLP-1s. In many cases, GLP-1 users are paying much more out-of-pocket to access the drugs for weight loss.
Take, for example, the cost for the same drugs using TrumpRx, the discount prescription drug platform launched by the Trump administration. The Wegovy tablet on TrumpRx costs $149 per month at minimum, while the Zepbound Kwikpen costs a minimum of $299. On GoodRx, another drug discount site, Foundayo costs as low as $149 per month, and the Wegovy injection is $199 at minimum.
Those prices are just starting points; each of these drugs can cost hundreds of dollars more per month as users reach higher dosage amounts or choose different providers.
Over the entire program period, eligible Medicare beneficiaries could save thousands of dollars on GLP-1s for weight loss. Over 18 months, the Bridge program would cost about $900 total, at $50 per month. At $200 per month for the same drug over the same time period, the total would be a much higher $3,600.
Who is eligible for the Medicare GLP-1 Bridge?
Beneficiaries with Medicare Part D prescription drug coverage in all states and U.S. territories can qualify for the program. Eligible plans include standalone Medicare drug plans or Medicare plans that include Part D drug coverage.
Those who were already eligible to receive a GLP-1 with Medicare for other conditions are not eligible. Recipients who already have GLP-1 access through Medicare should continue getting it in the same way. Similarly, recipients who have type 2 diabetes, mild-to-severe sleep apnea, or fatty liver disease are also not eligible, since GLP-1 access may already be available for them through Medicare.
Eligibility also depends on related medical information. In addition to the above, program participants must meet one of the following three criteria:
BMI of 35 or higher
BMI between 30 and 34.99 and diastolic heart failure, hypertension, stage 3a or higher chronic kidney disease, prediabetes, a previous heart attack or stroke, or blocked arteries in legs or arms
BMI between 27 and 29.99 and prediabetes, a previous heart attack or stroke, or blocked arteries in the legs or arms
How to apply for the program
To qualify for the Medicare GLP-1 Bridge program, eligible beneficiaries need a prescription from a doctor for one of the covered GLP-1 drugs for weight loss or weight management.
The doctor will send a prescription to a pharmacy. The pharmacy may then ask the doctor to complete a prior authorization based on the criteria above to confirm eligibility and that the GLP-1 is being used for weight loss. Doctors and pharmacies don’t need to opt into the program.
Once coverage begins, recipients will continue to receive single-month refills (and can get dose changes) for the same $50 cost of their GLP-1 through December 2027, when the Medicare GLP-1 Bridge program ends.