Medicare launched a temporary program Wednesday offering certain beneficiaries access to brand-name weight loss drugs for $50 monthly, marking the first time most older adults can get GLP-1 medications covered by insurance for weight loss alone. The Medicare GLP-1 Bridge program runs through December 31, 2027, but Congress hasn't authorized permanent coverage, leaving the initiative's future uncertain.
Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, told reporters the trial aims to collect data for potential longer-term coverage while providing immediate relief. "The sheer cost of these medications is a huge barrier to access," he said. "That ends today." But that relief comes with an expiration date and no clear path forward.
Who Qualifies and Who Doesn't
The program isn't open to all Medicare beneficiaries. Applicants must have Medicare drug coverage and meet specific criteria: a body mass index of 35 or higher, or a BMI of 27 or higher with another health condition such as a past heart attack or stroke, prediabetes, or conditions listed on the CMS website. BMI measurements count from when GLP-1 therapy started, allowing current users who've lost weight to qualify if they previously met the threshold.
Medicare beneficiaries with sleep apnea, diabetes, or fatty liver disease can't access the Bridge program. Their Medicare Part D insurance might cover GLP-1s separately based on those diagnoses. Of Medicare's more than 70 million enrollees, at least 10 million are overweight or obese, according to Juliette Cubanski, vice president and director of the program on Medicare policy at healthcare research nonprofit KFF. She noted a narrower slice of that group will actually qualify. Oz declined to estimate how many people could benefit.
To participate, beneficiaries must contact a healthcare provider who sends a prescription for covered GLP-1 drugs to a pharmacy and completes a prior authorization form. Covered medications include Eli Lilly's Foundayo tablets and Zepbound KwikPens, and Novo Nordisk's Wegovy injections and tablets. Cubanski said these GLP-1s have FDA approval for weight loss. The $50 monthly cost applies regardless of dosage, but those payments won't count toward deductibles or out-of-pocket maximums because Medicare, not the Part D insurer, subsidizes the prescription.
No Congressional Authorization, Limited Options
The program sunsets after December 31, 2027. Since Congress hasn't authorized Medicare to cover weight loss drugs permanently, the federal government faces limited options for continuing access. Congress could pass legislation allowing the drugs to be covered. CMS also could pursue a different voluntary pilot program called BALANCE, which the agency indefinitely delayed earlier this year when many Part D insurers were reluctant to sign up.
Oz told The Associated Press that a federal law permanently allowing coverage is "not essential right now" but something "for Congress to debate amongst themselves." He said CMS plans to "carefully track participation and outcomes" to determine whether extending the Bridge program or another solution works best. "We can't decide what's going to happen long term with Bridge until we see some of the data," he said, noting ongoing negotiations with drug companies to lower costs.
GLP-1s have surged in popularity in recent years, spurring dramatic weight loss in many patients. Their cost, sometimes hundreds of dollars monthly for higher doses, has blocked access. Gloria Dralla, a 78-year-old California resident who lost about 40 pounds after buying lower-cost Wegovy in Europe, told the AP the Bridge program means continuing a treatment that's improved her life. "This drug should be made available at a reasonable price for everybody who's got weight loss problems," she said.
Many Still Priced Out
Not everyone will access the drugs at an affordable price. Katie Smith, 71, in Virginia, said she isn't sure she'll qualify. She has a BMI of 33 but isn't certain she has another health condition meeting the requirements. Smith, whose mobility and exercise ability were severely limited by a spinal cord injury in her 20s, said she looked into getting the medications but was quoted $700 monthly, 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."
Why This Matters:
This trial program highlights the challenge of expanding entitlement benefits without Congressional authorization or sustainable funding mechanisms. Medicare's subsidy approach means taxpayers bear the cost while beneficiaries' payments don't count toward their out-of-pocket limits, creating unusual incentive structures. The program's 18-month timeline and uncertain future leave both patients and pharmaceutical companies without clarity on long-term access or pricing. With at least 10 million Medicare beneficiaries overweight or obese, the fiscal implications of permanent coverage could be substantial. The reluctance of Part D insurers to participate in the earlier BALANCE pilot suggests market skepticism about cost-effectiveness. Whether this trial produces data justifying broader coverage or reveals unsustainable expense will shape future debates about Medicare's role in covering lifestyle medications versus treating disease.