Medicare to Sell GLP-1 Weight-Loss Drugs for $50 a Month

Diabetes is not required. Here’s who may qualify, how to begin, and what to consider before starting treatment.

Some Medicare beneficiaries can now obtain prescription weight-loss medications for $50 a month, even if they do not have diabetes.

The Medicare GLP-1 Bridge program, which launched recently, gives eligible beneficiaries access to certain medications used for weight management. According to the Centers for Medicare & Medicaid Services, the temporary program is scheduled to continue through Dec. 31, 2027.

For people who have struggled with weight and the cost of treatment, the program opens the door to a conversation with a health care provider. But having Medicare, or simply wanting to lose weight, is not enough on its own.

Who Qualifies?

To participate, a beneficiary must have eligible Medicare Part D prescription drug coverage, either through a standalone drug plan or a qualifying Medicare Advantage plan that includes drug coverage.

Applicants also must be at least 18 and meet one of the following criteria when treatment begins:

• BMI of 35 or higher, without any additional qualifying condition.
• BMI of 30 or higher, plus certain heart failure, uncontrolled high blood pressure, or chronic kidney disease stage 3a or above.
• BMI of 27 or higher, plus prediabetes, a prior heart attack or stroke, or symptomatic blocked arteries in the arms or legs.

BMI, or body mass index, is based on height and weight. A health care provider can determine whether a patient meets the requirement.

The blood pressure standard is narrowly defined: CMS says it means blood pressure above 140 systolic or 90 diastolic despite treatment with two blood pressure medications. The qualifying heart failure condition is heart failure with preserved ejection fraction.

Diabetes Is Not Required

The Bridge is designed for people seeking medication for weight management who would otherwise not qualify for GLP-1 coverage through Medicare Part D.

People with type 2 diabetes, moderate to severe obstructive sleep apnea, or certain advanced fatty liver disease may qualify for GLP-1 medication through their regular drug plan instead. They are not included in the Bridge, and their out-of-pocket costs depend on their plan’s coverage rules.

How To Get Started

The first step is making an appointment with a doctor or another prescribing health care provider. Patients can ask whether they qualify for the Medicare GLP-1 Bridge and whether treatment is a good fit for them.

Covered products include Foundayo tablets, Wegovy injections or tablets, and Zepbound’s KwikPen. Zepbound single-dose pens and vials are not included.

The provider sends the prescription to the pharmacy and completes prior authorization when needed. The provider must also certify that the medication is paired with a lifestyle program focused on diet and exercise.

Medicare says patients will receive a coverage letter by mail.

Part D insurers do not have to opt into the Bridge for eligible members to participate, according to CMS.

Why Consider Treatment?

Weight-loss medication can help some people control hunger and maintain weight loss when used alongside changes in diet and physical activity.

The potential benefits go beyond the scale. According to the National Institute of Diabetes and Digestive and Kidney Diseases, losing 5% to 10% of starting weight may improve blood pressure, blood sugar, and triglyceride levels. Weight loss may also reduce joint pain and sleep apnea.

For someone weighing 200 pounds, that would mean losing 10 to 20 pounds. Results vary, and medication is not a substitute for healthy eating and exercise.

Understand the Costs and Risks

The $50 monthly copayment adds up to $600 for 12 monthly fills. However, those payments do not count toward a beneficiary’s Part D deductible or annual out-of-pocket maximum. Medicare’s low-income drug subsidies do not lower the Bridge copayment.

Patients should also talk with their provider about side effects and medical history. Common side effects include nausea, vomiting, diarrhea, and constipation. Depending on the medication, serious risks can include pancreatitis, gallbladder problems, and dehydration-related kidney injury. Some thyroid cancer histories can rule out certain medications.

Because the program is temporary, patients should ask how they would continue treatment after the program ends.

To check eligibility or get help, visit Medicare.gov/glp1bridge or call 1-800-MEDICARE (1-800-633-4227).