Medicare Weight-Loss Coverage Options You May Be Able to Use Now

Weight-Loss Coverage Through Original Medicare: Parts A and B

Medicare Part D

If you want to use a GLP-1 medication for weight loss, you may now qualify for coverage under Medicare Part D, the part of Medicare that covers prescription drugs. These medications were once excluded from Part D unless a person had certain related medical conditions, but some are now available through temporary coverage under the Medicare GLP-1 Bridge program. The monthly copay is $50.

The GLP-1 options that are covered include the orforglipron (Foundayo) tablet, semaglutide (Wegovy) prescription or injection, and a specific tirzepatide (Zepbound) pen.

Before the drug can be approved, your doctor must demonstrate to your insurer that you meet the requirements for GLP-1 coverage. You may qualify if you:

• Have a BMI of 35 or higher
• Have a BMI of 30 or higher along with uncontrolled high blood pressure, stage 3a or higher chronic kidney disease, or diastolic heart failure
• Have a BMI of 27 or higher and have prediabetes or peripheral artery disease, or have previously had a stroke or heart attack

The Medicare GLP-1 Bridge is scheduled to provide coverage for GLP-1 drugs through late 2027.

According to Kunkle Roberts, the Centers for Medicare and Medicaid Services is using the program to collect data that may influence future GLP-1 coverage, but there is no promise that the benefit will remain available in its current form. If you receive a GLP-1 through the Bridge program, keep an eye on updates from CMS and your Part D plan as the program’s end approaches.