Millions of older Americans may soon gain access to obesity drugs at a reduced price of $50 per month, beginning in July, through a new Medicare pilot program. While Medicare Part D already covers certain GLP-1 medications for conditions like diabetes, cardiovascular disease, and sleep apnea, the government program for individuals aged 65 and older had previously excluded coverage specifically for obesity. This new initiative will expand eligibility to more Medicare beneficiaries, including those with significant overweight, and individuals living with obesity alongside conditions such as prediabetes or uncontrolled hypertension. The $50 monthly cost, which covers any dosage, is considerably lower than the out-of-pocket expenses Medicare patients currently pay for GLP-1s.
Data from the Centers for Disease Control and Prevention indicates that approximately 40 percent of the 70 million Medicare enrollees meet the clinical definition of obesity. The Congressional Budget Office (CBO) estimates that 29 million Medicare beneficiaries would qualify for GLP-1 drug coverage under the new criteria, although 16 million already have access for other conditions such as diabetes or cardiovascular disease.
Despite the reduced cost, an additional $600 annually for a prescription could still pose a challenge for many older adults already contending with rising healthcare expenses. KFF, a health research organization, reported that in 2024, one in four Medicare beneficiaries earned less than $24,600, and half lived on incomes below $43,200.
Another significant concern surrounds the program’s longevity beyond 2027. While the pilot could potentially be extended, making the benefit permanent would necessitate a change in federal law and agreement from health insurance companies to include these medications in Part D prescription drug plans. Extending such coverage also raises questions about the financial burden on Medicare. The CBO estimated that adding weight-loss drugs permanently could cost Medicare $35 billion between 2026 and 2034. However, a spokesperson for the Centers for Medicare and Medicaid (CMS) noted that the agency has not publicly released its own cost estimates for either the pilot, officially named the Medicare GLP-1 Bridge program, or a potential permanent model.
The Medicare GLP-1 Bridge program is a temporary initiative open primarily to current enrollees in either a Part D prescription plan or a private Medicare Advantage plan that includes drug coverage. Eligibility extends to beneficiaries aged 65 and older, as well as those with disabilities. Importantly, Part D providers will not directly manage this coverage. Juliette Cubanski, deputy director of Medicare policy at KFF, explained that a Part D plan “will have nothing to do with making decisions about whether or not you can access a GLP-1 under the Bridge model.” Instead, a healthcare provider must assess whether a patient meets the program’s clinical requirements, which are based on body weight and health status. Patients with a body mass index (BMI) of 35 or higher will qualify, and those with a lower BMI may also be eligible if they have been diagnosed with other related conditions. Providers must submit a prior authorization request and a prescription to Humana, which is responsible for processing these requests. Approved prescriptions can then be filled at any pharmacy. The list of GLP-1s approved for obesity under this program includes Eli Lilly’s Foundayo and Zepbound KwikPen, and Novo Nordisk’s Wegovy, available in injectable and tablet forms. GLP-1 drugs prescribed for other conditions, such as diabetes, will continue to be covered under existing Part D plans.
The $50 monthly co-payment for the Bridge program operates independently of any Part D premiums or deductibles. Since Bridge purchases are processed outside of Part D, this monthly cost does not contribute toward Part D deductibles or annual out-of-pocket spending limits. While older adults with very low incomes typically receive assistance with Part D costs through the federal Extra Help program, this aid will not apply to the Bridge program because it functions outside Part D. Similarly, individuals with both Medicare and Medicaid coverage, who are usually exempt from or have minimal co-payments, would still be subject to the $50 monthly price. Ramsey Alwin, chief executive of the National Council on Aging, cautioned that “It could be difficult for low-income and modest-income older adults to participate and take advantage of the new coverage.” KFF reports that only about a dozen state Medicaid programs currently cover GLP-1 drugs for obesity treatment, despite having the option to do so.
Federal law prohibits Medicare from covering medications prescribed solely for weight loss, meaning permanent GLP-1 coverage would require an act of Congress. CMS, however, possesses the legal authority to run time-limited “demonstration projects” like the Bridge program to test new payment or coverage approaches. The federal government initially aimed to transition weight-loss drug coverage from the pilot to Part D by 2027. However, health insurance companies expressed reluctance due to the potentially high costs and a lack of sufficient historical data to accurately price plans for the following year, according to Kylie Stengel, a principal at Avalere Health. Stengel noted, “There’s really no historical data on GLP-1 use for obesity in Medicare, and insurance plans really need that data to assess that risk so that they can accurately set plan prices.”
A critical question remains regarding continued access to these drugs after the pilot concludes, especially since research indicates that most individuals need to remain on the medication to sustain weight loss or other health benefits. Dr. Cubanski stated there is no clear path forward, and much will depend on CMS’s ability to persuade more insurance plans to participate. She emphasized, “The really big question is what happens at the end of 2027 if C.M.S. isn’t able to stand up this model in Part D.” Even if Part D eventually covers GLP-1s for weight loss permanently, affordability will likely remain an issue for some, as cost-sharing is anticipated to exceed the pilot’s $50 monthly fee. A recent University of Pennsylvania study found that monthly cost-sharing for GLP-1 drugs already covered by Part D reached an estimated $167 last year. Matthew Klebanoff, an assistant professor of medicine at the University of Pennsylvania and a co-author of the study, predicted, “I’d expect similar costs for the weight-loss drugs, and maybe higher.” KFF polling further revealed that over half of GLP-1 users found these drugs difficult to afford, with one in four deeming them “very difficult.”
The pricing of these drugs introduces another layer of uncertainty. While drug manufacturers have agreed to supply weight-loss drugs to Medicare enrollees at a net price of $245 a month, representing a significant discount compared to commercial market prices, the long-term savings for Medicare are unclear. Potential reductions in obesity-related health conditions, such as metabolic, cardiovascular, and respiratory illnesses, could offset costs. The CBO’s estimate included $3 billion in savings over the period, a figure some researchers believe may be conservative. One research group projected savings of $18 billion over a decade. Elbert Huang, a professor of medicine at the University of Chicago and co-author of that study, highlighted, “We found large downstream reductions in the rates of diabetes and cardiovascular disease, in particular.”
Experts are particularly concerned about the combined issues of affordability and the uncertainty of permanent Part D coverage, fearing that millions of older individuals might begin GLP-1 treatment for obesity only to have it abruptly discontinued. Dr. Huang voiced significant apprehension about “people having yo-yo experiences with GLP-1 drugs,” explaining that “When people stop treatment, they not only regain the weight they had lost — but the weight they put back on is predominantly fat.” He concluded, “We’re about to do a giant national experiment on older adults in America.”
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