More than 70 million Americans enrolled in Medicare just gained a pathway to weight loss medications that've been financially out of reach for most older adults. Starting Wednesday, a new trial program called Medicare GLP-1 Bridge offers certain beneficiaries access to brand-name GLP-1 drugs for $50 a month through the end of 2027.
The program marks the first time most Medicare recipients can get these medications—glucagon-like peptide-1 receptor agonists—covered by insurance when used strictly for weight loss. At least 10 million Medicare enrollees are overweight or obese, according to Juliette Cubanski, vice president and director of the program on Medicare policy at the healthcare research nonprofit KFF. She said a narrower slice of that group will actually have access to the program.
Who Qualifies for Coverage
Eligibility requirements create significant barriers. To qualify, beneficiaries must have Medicare drug coverage and a body mass index of 35 or higher, or a BMI of 27 or higher alongside another health condition such as a past heart attack or stroke, prediabetes, or another condition from a list on the CMS website. BMI measurements are counted at the start of GLP-1 therapy, so even people who fall below the threshold now can qualify if they can show they had a high enough BMI when they began taking the drugs.
Medicare beneficiaries who have sleep apnea, diabetes, or fatty liver disease can't access the program. Their Medicare Part D insurance might cover their GLP-1s separately based on those diagnoses. The covered medications include Eli Lilly's Foundayo tablets and Zepbound KwikPens and Novo Nordisk's Wegovy injections and tablets—all FDA-approved for weight loss.
Dr. Mehmet Oz, the administrator of the Centers for Medicare & Medicaid Services, said he hopes the program can help his agency collect data to potentially work toward longer-term coverage while providing immediate relief to cash-strapped older Americans. "The sheer cost of these medications is a huge barrier to access," he said in a call with reporters. "That ends today." Oz declined to speculate on how many people could benefit, saying data from the program will reveal how many eligible beneficiaries choose to take the drugs.
The Cost Barrier Remains for Many
For those in the program, the cost is $50 per month regardless of dosage, but those payments won't count toward deductibles or out-of-pocket maximums because Medicare, rather than the Part D insurer, is subsidizing the prescription. GLP-1s have soared in popularity in recent years and have spurred dramatic weight loss in many patients, but their cost—sometimes hundreds of dollars a month for higher doses—has been a barrier.
Katie Smith, 71, in Virginia, said she isn't sure she will be eligible for the program. She has a BMI of 33 but isn't sure if she has another health condition that would allow her to meet the requirements. Smith, whose mobility and ability to exercise were severely limited by a spinal cord injury in her 20s, said she has looked into getting the medications but was quoted $700 a month, a price she can't afford. "I cannot tell you how frustrated I am," she said. "I have the drive and I have the willingness and I have the motivation, but I have not been able to lose weight in all the conventional ways."
For 78-year-old California resident Gloria Dralla, who told the AP she's lost some 40 pounds after buying lower-cost Wegovy in Europe, the Bridge program means being able to continue a treatment that has improved her life. "This drug should be made available at a reasonable price for everybody who's got weight loss problems," she said.
What Happens After 2027
The program is scheduled to sunset after Dec. 31, 2027. Since Congress hasn't authorized Medicare to cover weight loss drugs permanently, the federal government is limited in its options to keep the access flowing. Congress could pass a law to allow the drugs to be covered. CMS also could move forward with a different voluntary pilot program for covering the drugs called BALANCE, which the agency indefinitely delayed earlier this year when many Part D insurers were reluctant to sign up.
Oz said CMS plans to "carefully track participation and outcomes" to see whether an extension of the Bridge program or another solution is the best way to move forward. He told The Associated Press that a federal law permanently allowing the coverage is "not essential right now" but something "for Congress to debate amongst themselves." He said, "We can't decide what's going to happen long term with Bridge until we see some of the data," and noted that other negotiations with drug companies to lower costs are ongoing.
To access the program, beneficiaries must contact a health care provider who sends a prescription for one of the covered GLP-1 drugs to a pharmacy and fills out a prior authorization form, according to CMS.
Why This Matters:
This temporary program exposes the gap between medical innovation and healthcare access in America's safety net programs. While pharmaceutical companies have developed effective weight loss treatments, millions of older adults on fixed incomes have been priced out of medications that could improve their health outcomes and quality of life. The strict eligibility requirements mean many Medicare beneficiaries who could benefit—like those with a BMI of 33 without qualifying comorbidities—remain locked out even under this expanded access. The program's 2027 sunset date without guaranteed permanent authorization leaves vulnerable seniors facing potential loss of treatment and underscores how Congressional inaction on prescription drug coverage creates uncertainty for patients who depend on Medicare. Whether this leads to lasting policy change or simply provides a brief window of relief depends on data collection, political will, and negotiations with pharmaceutical manufacturers—leaving healthcare access subject to factors beyond patients' control.