Starting July 1, some Medicare patients will get their first opportunity to access GLP-1 medications for weight loss under a new program aimed at making these drugs more affordable. The Medicare GLP-1 Bridge program allows eligible beneficiaries to pay a monthly copay of $50 for weight-loss medications produced by Eli Lilly and Novo Nordisk, such as Zepbound, Foundayo, and Wegovy.
According to Juliette Cubanski, vice president and director of Medicare policy at the health care research nonprofit KFF, the program does not entail a change in existing laws but rather leverages a specific section of Medicare law that permits the establishment of a temporary program. This initiative represents a significant shift, as it marks the first occasion wherein Medicare will offer partial coverage for medications prescribed specifically for obesity, rather than only for patients with conditions like diabetes or cardiovascular disease.
Despite recent reductions in out-of-pocket costs by drug manufacturers, many patients still faced monthly bills of approximately $350 for these GLP-1 medications. The coverage through the Bridge program will be available from July 1, 2026, until December 31, 2027. After this trial period, the continuity of coverage for weight-loss GLP-1s will depend on the decisions of the Centers for Medicare & Medicaid Services or potential changes in legislation.
To qualify for the program, Medicare beneficiaries must have Part D coverage and be enrolled in an eligible plan. Their healthcare provider needs to submit a prior authorization request indicating that the patient is being prescribed a GLP-1 for weight loss. Providers will have to demonstrate that patients meet specific clinical criteria related to body mass index (BMI) and other health conditions. Eligibility requirements state that patients must have:
– A BMI of at least 35
– A BMI of at least 30, coupled with a history of heart failure, uncontrolled hypertension, or chronic kidney disease
– A BMI of at least 27 alongside prediabetes, a past heart attack or stroke, or symptomatic peripheral artery disease
Patients who are already prescribed a GLP-1 medication under Medicare Part D for other conditions, such as Type 2 diabetes or sleep apnea, will not qualify for this program. KFF estimates that approximately 3.8 million Medicare beneficiaries will meet these eligibility requirements.
Cubanski advises interested patients to consult their healthcare providers to discuss their eligibility for the drugs. The medications covered under this program include Eli Lilly’s Foundayo, a daily weight-loss pill, and Zepbound KwikPen, a weekly injection, along with Novo Nordisk’s Wegovy, available in both injection and pill forms.
While the monthly copay for eligible patients stands at $50, it’s important to note that this charge is not accounted for in the patient’s deductible or yearly out-of-pocket maximum. While participants will not need to meet their deductible to qualify for the copay, it will not contribute toward the out-of-pocket cap set at $2,100. Additionally, patients cannot utilize coupons or discounts to further lower the price of these medications.
