U.S. — The federal government has launched the Medicare GLP-1 Bridge program, offering selected brand-name GLP-1 medications to certain Medicare and Medicare Advantage beneficiaries for $50 per month. The program is set to run until the end of 2027.

This initiative represents the first opportunity for most older adults to obtain GLP-1 medications covered by insurance when used specifically for weight loss. Mehmet Oz, Administrator of the Centers for Medicare & Medicaid Services, stated that the program aims to provide immediate relief to older Americans and collect data to inform potential longer-term coverage. "The sheer cost of these medications is a huge barrier to access," Oz said. "That ends today."

To qualify for the Medicare GLP-1 Bridge program, beneficiaries must have Medicare drug coverage. They must also have a body mass index (BMI) of 35 or higher, or a BMI of 27 or higher along with an additional health condition, such as a prior heart attack, stroke, or prediabetes. BMI measurements are assessed at the beginning of GLP-1 therapy for eligibility. Individuals who already receive GLP-1 drugs for conditions like diabetes or sleep apnea do not qualify for this program; however, Medicare Part D insurance may cover these medications separately for those diagnoses.

The covered medications include Eli Lilly's orforglipron (Foundayo) tablets and tirzepatide (Zepbound) KwikPens, as well as Novo Nordisk's semaglutide (Wegovy) injections and tablets. Juliette Cubanski, Vice President and Director of the Program on Medicare Policy at KFF, noted that these GLP-1 agonists have received FDA approval for weight loss. Providers are required to send a prescription for a covered GLP-1 drug to a pharmacy and complete a prior authorization form for qualifying patients. The $50 monthly cost remains constant regardless of the dosage; however, these payments do not count towards insurance deductibles or out-of-pocket maximums.

The program is scheduled to conclude after December 31, 2027, as Congress has not authorized permanent Medicare coverage for weight-loss drugs. Oz stated that CMS intends to track participation and outcomes to determine future steps. He said in a podcast interview that a federal law for permanent coverage is "not essential right now" but a matter "for Congress to debate amongst themselves." Oz added, "We can't decide what's going to happen long term with Bridge until we see some of the data."

Katie Smith, a 71-year-old Virginia resident with a BMI of 33, has considered GLP-1 medications but was quoted $700 per month, a price she stated she cannot afford. She also said she was unsure if she possessed another health condition that would fulfill the program's requirements. "I have the drive and I have the willingness and I have the motivation, but I have not been able to lose weight in all the conventional ways," Smith said. "I cannot tell you how frustrated I am."

Why It Matters

The Medicare GLP-1 Bridge program addresses access to GLP-1 medications for weight loss for Medicare beneficiaries, a demographic with at least 10 million individuals who are overweight or obese, according to Juliette Cubanski of KFF. The program provides a subsidized cost for these medications until 2027, making them available to some older adults for the first time via insurance for weight management. The collection of data from this temporary program will inform future policy decisions regarding long-term coverage, which currently requires congressional authorization.