Medicare’s Bridge Weight-Loss Program Starts Strong, Yet Obstacles Persist

The Trump administration’s Bridge program gives eligible Medicare beneficiaries access to weight-loss drugs for $50 a month, and since its July rollout it has gotten off to a solid start. Even so, important hurdles remain, including a large gap between the more than 1.1 million beneficiaries who have enrolled and the roughly 700,000 who have actually filled a prescription. Prior authorization requirements, strict clinical rules at treatment start, and delays in claims handling could all be slowing the program’s progress.

The Bridge program is a temporary demonstration that runs through December 2027. It allows people over 65 and certain disabled beneficiaries to use select glucagon-like peptide-1 medications for obesity, including Zepbound (tirzepatide), Foundayo (orforglipron) and Wegovy (semaglutide). Those who qualify pay a flat $50 each month, regardless of income. The federal government’s net monthly cost per prescription is $245, which is paid directly to drug makers after subtracting the patient’s share.

CMS says patients cannot have type 2 diabetes, moderate-to-severe sleep apnea or metabolic dysfunction-associated steatohepatitis in order to qualify. Although GLP-1 drugs are used for obesity, they are also used for conditions such as those excluded from the program, as well as chronic kidney disease and cardiovascular risk reduction.

The agency’s rationale is that those excluded conditions are already covered indications under standard Medicare outpatient drug coverage, known as Part D.

Beneficiaries also must meet body mass index thresholds: a BMI of 35 or higher, or a BMI between 27 and 35 if they have an obesity-related comorbidity. A KFF analysis found that about 3.8 million beneficiaries meet all the clinical and insurance requirements out of nearly 10 million Part D enrollees who satisfy the broader weight-related BMI criteria.

Although GLP-1 drugs are popular and have shown strong results, federal law still bars Medicare from covering them for weight loss alone. To work around that restriction, the Trump administration created Bridge alongside a five-year pilot program called BALANCE, short for Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth. BALANCE is meant to widen obesity treatment access in Medicare and Medicaid while also providing manufacturer-backed lifestyle support.

Lower negotiated drug prices were supposed to make Part D plan participation in BALANCE more attractive. Instead, the demonstration had to be paused indefinitely in Medicare because too few plan sponsors signed on; the program needed participation from 80% of plans and did not reach that mark. BALANCE is still moving forward in Medicaid, and Bridge remains in place.

There are still practical problems with Bridge. To take part, beneficiaries must be enrolled in Medicare Part D, either through a standalone prescription plan or a Medicare Advantage plan that includes drug coverage. Millions of Medicare beneficiaries do not have Part D coverage and are therefore not eligible.

Because Bridge operates outside normal Medicare Part D networks and relies on Humana as a single central processor, doctors’ offices and pharmacies must work through several administrative steps. Every GLP-1 prescription begins with an automatic prior authorization process. The pharmacy first submits the claim to the patient’s Part D plan and receives an initial denial. Eligibility is then determined through prior authorization, based on the patient’s BMI when GLP-1 treatment began rather than their current BMI. That can be difficult for people who previously bought obesity medicines through direct-to-consumer cash-pay services outside the traditional insurance system, where records are often incomplete or missing.

The program’s flat $50 monthly copayment can also create affordability issues. Patients receiving Part D low-income subsidies, who are often used to paying little or nothing out of pocket, do not get a lower amount. For some seniors and disabled beneficiaries, even $50 a month remains a meaningful cost. The copay also does not count toward a beneficiary’s deductible or annual out-of-pocket maximum.

Large pharmacy chains such as Walgreens say about half of the Medicare beneficiaries receiving GLP-1 drugs through Bridge are new to the medications. That suggests many of the more than 700,000 people who have already filled prescriptions are starting treatment for the first time. Novo Nordisk has also said it is seeing increased prescription volume tied to the program.

Still, the gap between approved enrollees and actual users remains striking. Chris Klomp, director of the Center for Medicare, said that at least 1.1 million Medicare enrollees have been approved and signed up for Bridge. The difference of more than 400,000 people may reflect delays tied to prior authorization and claims processing.

Another unresolved issue is what happens when the program ends in 2027. Pressure is likely to mount on the Trump administration to extend Bridge. Congress would then have to decide how to respond to a costly federal initiative at a time of rising deficits. The Congressional Budget Office has estimated that if every eligible beneficiary enrolled, annual taxpayer spending could top $30 billion. Full participation is unlikely, but if roughly 20% are already using the drugs, annual costs would still exceed $6 billion, potentially limiting resources for other healthcare priorities.

If the pilot expires without a successor, beneficiaries could face a major coverage cliff in 2028, when a drug that costs $50 a month under Bridge would suddenly become much more expensive.

If lawmakers later move to lift Medicare’s ban on obesity-drug coverage — a possibility given bipartisan interest in changing the law — Medicare Advantage plans and standalone drug plans would face new financial pressure because they would be responsible for at least part of the cost. Even if insurers could use the federal government’s negotiated net price of $245 per prescription, the size of the population seeking these drugs could strain budgets. It is also far from certain that GLP-1 coverage would save money overall, which helps explain why insurers have been cautious about covering weight-loss drugs in both commercial and public plans.