Some Medicare patients will be able to access to GLP-1 medication for weight loss for the first time starting July 1, paying a $50 monthly copay through a new program designed to make the drugs more affordable.
Called Medicare GLP-1 Bridge, the pilot program expands access to weight-loss drugs made by Eli Lilly and Novo Nordisk, including Zepbound, Foundayo and Wegovy.
“Medicare is not changing the law right now,” said Juliette Cubanski, vice president and director of Medicare policy at the health care research nonprofit KFF. “What it’s doing is taking advantage of a specific section of the law that gives the federal government the ability to stand up a temporary program.”
The program marks the first time Medicare will help pay for drugs prescribed solely for obesity, rather than limiting coverage to people taking GLP-1s for conditions such as diabetes or cardiovascular disease. Drugmakers have lowered out-of-pocket costs in recent months, but many patients still pay about $350 a month.
GLP-1 coverage through the bridge program will run between July 1, 2026, and December 31, 2027. After that 18-month trial, patients could lose access to Medicare coverage for GLP-1s used for weight loss unless the Centers for Medicare & Medicaid Services issues an extension or Congress changes the law, according to Cubanski. It’s possible drug manufacturers could also lower their current direct-to-consumer pricing to match the $50 copay, she said.
“In the short term, we have this temporary program, and then no clear path forward yet as to what will happen at the end of 2027,” she said.
Medicare beneficiaries with Part D coverage enrolled in an eligible plan can get coverage through the Bridge program.
To qualify, a patient’s provider must submit a prior authorization requestshowing that the patient is being prescribed a GLP-1 for weight loss. Prior authorization is a process that clears the way for a pharmacy to fill a prescription.
Providers must also demonstrate that their patient meets certain clinical criteria related to their body mass index (BMI) and health conditions when they first start taking a GLP-1. They must either have:
Patients are not eligible for coverage through the Bridge program if they already have a GLP-1 prescription under Medicare Part D for certain conditions, such as Type 2 diabetes and sleep apnea, according to Cubanski.
“Certainly, for patients who may think that they’re eligible for these drugs or are interested in exploring whether they’re eligible, a good first step is to talk to their clinician who can help them,” Cubanski said.
Eli Lilly’s Foundayo, a daily weight loss pill, as well as Zepbound KwikPen, a weekly weight loss injection, are covered, along with Novo Nordisk’s Wegovy weight loss medication in injection and pill form.
Medicare recipients who meet the eligibility requirements will have to pay a $50 monthly copay to access the GLP-1 drugs. However, there are a few things to keep in mind. Because the program is being offered outside Medicare Part D coverage, the copay doesn’t count toward a patient’s deductible or yearly out-of-pocket cap.
“The good news is they don’t have to meet their deductible in order to qualify for the $50 copay,” Cubanski said. “But on the other hand, the $50 copay doesn’t count towards their $2,100 out-of-pocket cap.”
In addition, patients aren’t allowed to apply coupons or discounts to lower the price further.
