Medicare beneficiaries for the first time will be eligible for coverage of breakthrough GLP-1 weight-loss medications after years of struggling to get the drugs to more seniors.Starting July 1, eligible patients can get GLP-1s to treat obesity for just $50 per month as part of a test program for Medicare, the social safety net health insurance program for seniors over age 65.Medicare Part D, the prescription drug benefit program, already covers some GLP-1 medications for conditions including Type 2 diabetes and heart disease, but federal law prohibits coverage solely for obesity.
Earlier this year, the Trump administration’s Center for Medicare & Medicaid Services, headed by Dr. Mehmet Oz, created a temporary demonstration program that sidesteps the law to allow more beneficiaries to access GLP-1s, including those who are overweight with conditions such as prediabetes and uncontrolled high blood pressure. The Medicare GLP-1 Bridge is a temporary pilot program that begins on July 1 and is scheduled to last through 2027. It was formulated as part of the Trump administration’s “most favored nations” drug price negotiations, in which U.S. patients are charged at the lowest price comparable to other developed countries. Bipartisan groups of lawmakers, most of whom are either physicians or healthcare providers by training, have attempted to advance legislation to change GLP-1 medication coverage for Medicare seniors, but the move has been seen as too costly.The new program could give millions of seniors access to Eli Lilly’s Mounjaro and Zebpound as well as Novo Nordisk’s Ozempic and Wegovy, which have been proven to reduce the risk of heart attacks, strokes, and other chronic conditions. But the experiment could be short-lived if the program is not extended beyond 2027 or if private insurance companies that manage Medicare benefits do not begin covering the medication under other CMS carveouts.Here is everything you need to know about how patients can access the medications and what it means for Medicare in the long term.Who is eligible, and how can patients get the medications?
