Medicare now covers GLP-1 weight-loss drugs for $50 a month: See if you're eligible
Millions of Americans may be eligible to get blockbuster GLP-1 drugs like Wegovy and Zepbound for a much lower price starting July 1 under Medicare’s GLP-1 Bridge program.
by A. Pawlowski | TODAY · 5 NBCDFWPopular GLP-1 weight-loss drugs are becoming much more affordable for millions of older adults starting Wednesday, July 1, as Medicare begins to cover them — for now.
The Medicare GLP-1 Bridge is a temporary pilot program that allows eligible Medicare recipients to get blockbuster anti-obesity medications like Wegovy and Zepbound for $50 a month.
Medicare is federal health insurance for people who are 65 or older. The GLP-1 Bridge is temporary because current federal law doesn’t allow Medicare Part D — the part that helps pay for prescriptions drugs — to cover medications prescribed purely for weight loss. (Medicare does cover GLP-1 drugs when they’re prescribed for Type 2 diabetes, cardiovascular disease and other health problems.)
“In order to get it permanent, it literally takes an act of Congress. Congress has to change the law,” said NBC News medical contributor Dr. John Torres on TODAY.
The temporary plan is a workaround to give Medicare recipients quicker access to the medications, he added.
Almost 40% of Americans over age 65 have obesity, according to government statistics.
GLP-1 drugs are effective at helping people lose weight by reducing appetite and cravings. But they can also cost hundreds of dollars a month without insurance.
So the government is trying out what it calls a “short-term demonstration” to test access to GLP-1 drugs for Medicare recipients.
Many people in the Medicare population probably stand to experience substantial benefit from these drugs, says Dr. Harlan Krumholz, a cardiologist and professor at the Yale School of Medicine.
“I’m tremendously excited that we’re addressing the access and affordability issues for people so that they have that option,” Krumholz, director of the Yale New Haven Hospital Center for Outcomes Research and Evaluation, tells TODAY.com.
“(But) the older you are, the less evidence there is from any trial about you, because most of these trials haven’t really enrolled people over 70 or 80, so we need to continue to learn and see how this works. ... Especially in older populations, we need to continue to gather more evidence.”
Older people, in particular, are at greater risk for health problems at lower body weights, he adds.
The new program will operate outside of Medicare Part D and is scheduled to end on Dec. 31, 2027, while longer term solutions are being discussed.
Organizers hope that, by the end of next year, the pilot program will have shown that it saves money and improves health so that it will be extended and “Congress will say, ‘Let’s keep it going,’” Torres said.
GLP-1s can lead to many benefits beyond weight loss, he added.
“We know that even with the right diet and exercise, many patients will struggle to lose the weight they need to lose for their health. For these individuals, GLP-1 drugs can be truly transformative,” said Dr. Mehmet Oz, administrator for the Centers for Medicare & Medicaid Services, in a statement.
“They can reduce the risks of myocardial infarction, stroke, kidney disease, chronic joint pain — all this can also reduce costs in our precious Medicare program.”
Here’s what to know about the Medicare GLP-1 Bridge, according to the program’s website:
Which GLP-1 drugs are covered?
The list includes these medications:
- Wegovy (weekly injection or daily pill)
- Zepbound (weekly injection)
- Foundayo (daily pill)
What is the cost?
It’s a flat $50 co-pay to your pharmacy for a one-month supply.
Who is eligible?
You must meet these four requirements:
- You have Medicare Part D drug coverage.
- You don’t already get a GLP-1 drug covered through Medicare.
- You don’t have Type 2 diabetes, moderate-to-severe sleep apnea or fatty liver disease (since Medicare may already cover GLP-1 drugs for those conditions).
- You’re at least 18 and at least one of these is true:
- Your BMI is 35 or higher.
- Your BMI is 30 or higher, and you have diastolic heart failure, high blood pressure, chronic kidney disease, prediabetes, a previous heart attack or stroke or peripheral artery disease.
- Your BMI is 27 or higher, and you have prediabetes, a previous heart attack or stroke or peripheral artery disease.
More than 56 million Americans have Medicare Part D, according to the Centers for Medicare & Medicaid Services.
If about 40% of them have obesity, as statistics suggest, that translates into 22 million people who may be able to take part in the new program — depending on their weight and health.
How to apply
If you qualify for the Medicare GLP-1 Bridge, your doctor has to send a prescription for the GLP-1 drug to your pharmacy and complete a prior authorization when requested.
It will be valid for refills and dose changes through Dec. 31, 2027, unless you change GLP-1s.
This story first appeared on TODAY.com. More from TODAY: