Medicare Pilot to Lower Some GLP-1 Costs Soon
A new federal pilot program will allow eligible Medicare Part D enrollees to buy selected GLP-1 weight-loss medicines for $50 per month. The Department of Health and Human Services says the Medicare GLP-1 Bridge program will begin July 1 and run through Dec. 31, 2027.
The initiative applies to Wegovy, Foundayo and Zepbound KwikPens. Zepbound single-use pens and vials are not included. Officials estimate up to 14 million people could qualify. Medicare has generally not covered drugs prescribed solely for weight loss, and the pilot temporarily changes that rule for qualifying patients.
Eligibility is tied to weight management treatment and specific health criteria. Patients may qualify with a body mass index of 35 or higher; a BMI of 30 or higher with conditions such as heart failure, uncontrolled hypertension or chronic kidney disease; or a BMI of 27 or higher with risks such as prediabetes or peripheral artery disease.
The $50 monthly payments will not count toward the Medicare Part D deductible or the annual out-of-pocket spending cap. GLP-1 medications can otherwise cost from about $149 to more than $1,300 per month, depending on coverage and payment arrangements.
Medical and policy experts said the program could expand access for beneficiaries who cannot afford the drugs. They also noted limitations, including the temporary duration, the exclusion of some formulations and uncertainty about what happens after 2027. Some warned that stopping treatment could contribute to weight regain.
GLP-1 drugs work by reducing appetite and helping regulate blood sugar. They are used for weight management and type 2 diabetes, and research suggests possible cardiovascular and cognitive benefits. Common side effects include nausea, dizziness, headache, fatigue, diarrhea, constipation and bloating. Clinicians emphasized that diet, physical activity, strength training and sleep remain important for lasting weight management.