Key Takeaways
- The Medicare GLP-1 Bridge program will cover weight loss drugs for a $50 monthly copay for eligible beneficiaries through Dec. 31, 2027.
- Medicare currently does not cover GLP-1 drugs for weight loss alone.
- Eligible patients must meet BMI and health criteria and obtain prior authorization to access the benefits.
Medicare beneficiaries will see a major drop in the cost of GLP-1 drugs for weight loss soon, at least for a limited time.
A new Medicare GLP-1 Bridge program launching in July will allow eligible beneficiaries to access these drugs for a $50 monthly copay. That is a significant reduction from the more than $1,000 out-of-pocket cost each month, and lower than the current $149 to $249 monthly cost under the White House drug pricing initiative, TrumpRx. The temporary program is scheduled to run until Dec. 31, 2027.
“We’re really encouraged by the steps the administration is taking to improve access to obesity treatment,” said Tracey Zvenyach, vice president of Advocacy & Research at the Obesity Action Coalition. “It’s been overdue and much needed.”
Why Medicare Doesn’t Cover Weight Loss Drugs
Right now, Medicare covers GLP-1 drugs under Part D only for conditions such as cardiovascular disease, type 2 diabetes, or sleep apnea—not for weight loss alone. A 2003 law prohibits Medicare from covering weight loss medications, largely due to safety concerns tied to earlier drugs like Fen-Phen, which was later found to be harmful.
The cost of weight loss drugs is another major concern. About 42% of adults age 60 and over have obesity, according to the National Council on Aging. Covering anti-obesity medications under Medicare Part D could cost the program between $25 billion and $35 billion over 10 years, according to KFF estimates.
Who’s Eligible for the GLP-1 Bridge Program?
Under the new program, healthcare providers may prescribe GLP-1 drugs for obesity so long as patients meet eligibility requirements, such as:
- A BMI of 35 or higher.
- a BMI of 30 or more when starting GLP-1 drugs, so long as they also have heart failure, uncontrolled hypertension, or kidney disease.
- A BMI of 27 or more as well as a previous stroke, prediabetes, a previous heart attack, or peripheral artery disease.
Patients must be enrolled in a Medicare Part D plan or a Medicare Advantage plan in order to access the temporary GLP-1 benefit.
To use the program benefits, doctors must submit a prior authorization request to a central processing center, confirming that the patient has received counseling on lifestyle changes while taking GLP-1 drugs. Patients can fill their prescription once the request is approved and the pharmacy is notified.
Adam Colborn, vice president of government affairs at the Academy of Managed Care Pharmacy, said the process may initially cause confusion. Providers may assume coverage falls under a patient’s Part D plan, but pharmacists cannot dispense the medication until the central processing center approves the prior authorization.
Medicare hasn’t released details about processing, Colborn said, but it could take a day or more for the authorization to come through.
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Which GLP-1 Drugs Are Included?
The Bridge program won’t include all GLP-1 drugs, according to Medicare. Only Foundayo (a new GLP-1 pill from Eli Lilly), Wegovy (both injectables and oral pills), and the Zepbound KwikPen will be covered.
What Else You Should Know About GLP-1 Costs and Risks
It’s important to know that GLP-1 co-pays do not count toward someone’s Medicare spending cap of $2,100 this year, said Juliette Cubanski of KFF. That’s the cap at which Medicare covers the full cost of drugs you take if you go over that amount.
Older adults may also be more likely to have gastrointestinal side effects from GLP-1 drugs and to stop taking them because of cost and side effects, according to a 2024 review published in the journal Obesity. GLP-1 drugs may also interact with other medications that patients take and increase the risk of falls because of dehydration that’s been associated with the drugs, said Alissa Chen, MD, an obesity specialist at the Yale School of Medicine and the first author of the review.
“These medications for obesity were largely tested in younger adults, not as much in older adults, and so what we know about how they impact older adults is far less, and it really matters because older adults are a highly heterogeneous population,” Chen told Verywell.
Once the Bridge program launches, telehealth providers could start advertising easy access to the benefits. “With any new program, there’s always an opportunity for consumers to perhaps be taken advantage of,” said Emily Whicheloe, Director of Education at the Medicare Rights Center in New York City.
However, Whicheloe said it’s best if you can see a physician you’re already familiar with. Try to be “a little bit skeptical if an offer seems too good to be true,” she added,” especially if a provider is offering a five-minute online appointment or offers for the drugs at a lower price or copay.
