A major shift in federal health coverage is coming. Starting July 1st, the Centers for Medicare & Medicaid Services will launch its GLP-1 Bridge program, allowing eligible older adults to receive popular weight-loss medications like Wegovy and Zepbound.
This is a significant change. Medicare has long been prohibited from covering drugs specifically for weight loss. The new program will run through 2027, with enrollees paying a $50 monthly copay while Medicare covers the remainder.
The move comes as private employers are increasingly dropping coverage for these expensive drugs, which can have list prices over $1,000. A recent Mercer survey found that 6% of large employers plan to stop covering GLP-1s by 2026.
To qualify, beneficiaries must have Part D prescription drug coverage and a doctor's prescription. Eligibility is based on body-mass index: generally 35 or higher, or 27 or higher with conditions like pre-diabetes or heart disease. Those already receiving the drugs for Type 2 diabetes or other conditions will not be covered under this new bridge program.
Medicare will handle all approvals and payments directly, bypassing the private insurers that administer Part D plans. The program could provide financial relief to millions. KFF data shows 9% of adults 65 and older already use GLP-1 drugs, and an estimated 13.7 million Medicare recipients are classified as overweight or obese.
The covered medications include Novo Nordisk's Wegovy (injectable and pill) and Eli Lilly's Zepbound injectable and its weight-loss pill Foundayo. Both drugmakers have recently cut prices for cash-paying customers.