Medicare now covers GLP-1 weight loss drugs for eligible beneficiaries
by Mary McCue Bell · The Washington TimesMedicare is covering GLP-1 weight loss medication for the first time for many older adults.
Eligible Medicare beneficiaries will now have access to GLP-1 drugs through a $50-a-month copay through the Medicare GLP-1 Bridge, a Centers for Medicare & Medicaid Services initiative launched Wednesday.
Brand-name medications, such as those made by Eli Lilly and Novo Nordisk, including Zepbound, Foundayo and Wegovy, will now be available through the end of 2027.
Almost 4 million beneficiaries could be eligible under the new initiative, according to a Monday KFF analysis of 2023 Medicare Part D enrollment data.
“For too long, many Americans have been unable to access these treatments because of cost,” CMS Administrator Dr. Mehmet Oz said in a statement. “The Medicare GLP-1 Bridge creates a new pathway for eligible beneficiaries to afford GLP-1 medications.”
Under the primary federal health insurance program in the U.S. for individuals 65 and older, the new benefit will only apply to those who use the drug strictly for weight loss and meet weight and health requirements. Individuals who already receive GLP-1 medications through their existing Medicare prescription drug coverage or are eligible for separate Medicare GLP-1 coverage, Medicare Part D, are excluded.
To qualify, Medicare patients generally need a body mass index of 35 or higher. Patients with a BMI of 30 or higher may also qualify if they have a condition such as heart failure, high blood pressure or chronic kidney disease.
And patients with a BMI of 27 or higher may qualify if they have pre-diabetes or a history of heart attack, stroke or peripheral artery disease.
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They will also need prior authorization and must wait for the prescription to be approved before it is filled.
Federal law historically banned Medicare from covering weight-loss drugs until now. Previously, coverage was limited to people taking GLP-1s for conditions such as diabetes or cardiovascular disease.
The federal government has also pursued two separate efforts to lower GLP-1 prices for Medicare.
The Trump administration struck a “most-favored-nation” deal with Eli Lilly and Novo Nordisk, setting Medicare’s net price for these drugs at $245 a month — the price used for the GLP-1 Bridge program.
Separately, under the Medicare Drug Price Negotiation Program, CMS negotiated a $274-a-month price for Ozempic, Wegovy and Rybelsus, set to take effect in 2027.
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CMS has completed two negotiation cycles so far: the first set of 10 drugs took effect in 2026, and a second set of 15 drugs, including Ozempic and Wegovy, takes effect in 2027.
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Mary McCue Bell
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