Medicare Launches $50 GLP-1 Weight-Loss Drug Pilot

Medicare has launched a new pilot program offering GLP-1 weight-loss drugs for $50 monthly co-pays starting July 1, according to multiple reports. The initiative, called Medicare GLP-1 Bridge, provides access to medications like Novo Nordisk's Wegovy and Eli Lilly's Zepbound and Foundayo for eligible beneficiaries aged 65+ or with disabilities.

The program marks the first time Medicare will cover drugs prescribed solely for obesity rather than other conditions. Eligible patients must meet specific BMI criteria: a BMI of at least 30 plus certain health conditions, or a BMI between 27-29.9. Those already covered for GLP-1s through Medicare Part D are not eligible.

The pilot will run until the end of 2027, with uncertain long-term prospects. According to CBS News and KFF estimates, about 3.8 million Medicare beneficiaries could qualify under these requirements. However, experts warn about potential challenges in managing older adults' weight loss safely and effectively.

Clinicians have expressed concerns about the program's sustainability and implementation. As reported by Reuters, Dr. John Batsis from UNC Chapel Hill noted that access to clinical support may not keep pace with drug availability. Additionally, rapid weight loss in older adults could lead to muscle mass loss and reduced bone mineral density.

Medicare Administrator Dr. Mehmet Oz told reporters that CMS plans to track participation and outcomes carefully. The program's future beyond 2027 remains uncertain, as it will depend on data collected during the pilot phase and potential congressional action. According to Los Angeles Times, Oz hopes the program can help collect data for longer-term coverage while providing immediate relief to cash-strapped older Americans.

To qualify, enrollees must have a body mass index of 35 or higher, or a BMI of 27 or higher alongside another health condition. Medicare beneficiaries who have sleep apnea, diabetes, or fatty liver disease cannot access the program but may get coverage through Medicare Part D based on those diagnoses.

The covered medications include Eli Lilly’s Foundayo tablets, Zepbound KwikPens, and Novo Nordisk’s Wegovy injections and tablets. For those in the program, the cost is $50 per month, regardless of dosage. However, these payments won’t contribute to their insurance deductibles or out-of-pocket maximums as Medicare is subsidizing the prescription.

The program is scheduled to sunset after Dec. 31, 2027. Congress could pass a law to allow the drugs to be covered permanently, or CMS could move forward with a different voluntary pilot program called BALANCE. Oz noted that other negotiations with drug companies to lower costs are ongoing.