SouthernWorldwide.com – A significant change in Medicare coverage is set to dramatically reduce the cost of weight-loss drugs for eligible seniors, beginning July 1. This new federal pilot program, named the Medicare GLP-1 Bridge, aims to expand access to popular GLP-1 medications such as Wegovy and Zepbound.
The initiative will provide selected brand-name medications to certain Medicare and Medicare Advantage beneficiaries at a cost of $50 per month. This was reported by The Associated Press.
The medications covered under this trial include Eli Lilly’s Foundayo tablets and Zepbound KwikPens, as well as Novo Nordisk’s Wegovy injections and tablets. All of these drugs have received FDA approval for weight loss, according to the report.
This pilot program is a landmark moment, marking the first time GLP-1s (glucagon-like peptide-1 receptor agonists) will be covered by insurance specifically for weight loss purposes.
Prior to this Medicare trial, seniors seeking GLP-1s solely for obesity faced substantial monthly costs. For instance, Novo Nordisk’s Wegovy (semaglutide) could cost between $1,350 to $1,650 per month, while Lilly’s Zepbound (tirzepatide) was approximately $1,086 monthly. However, both manufacturers did offer some cash-pay options that could lower these prices for eligible individuals.
There are specific criteria for eligibility for this coverage. Older adults must have had a body mass index (BMI) of 35 or higher when they commenced GLP-1 therapy. Alternatively, a BMI of 27 or higher combined with another health condition, such as a history of heart attack, stroke, or prediabetes, is also required.
Individuals who already have insurance coverage for other conditions, including diabetes and sleep apnea, are not eligible to participate in this specific program.
According to Juliette Cubanski, vice president and director of the program on Medicare policy at the healthcare research nonprofit KFF, over 70 million Americans are enrolled in Medicare. Of these, approximately 10 million are classified as overweight or obese.
“For many older Americans living with obesity, this is a moment they and their families have been waiting for,” stated Jamey Millar, Novo Nordisk’s executive vice president of U.S. operations, in a press release. He added that the Medicare GLP-1 Bridge program offers a new, affordable pathway to an FDA-approved treatment that was previously inaccessible due to cost.
Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, expressed hope that the program will enable his agency to gather valuable data. This data could inform future decisions about longer-term coverage options while providing immediate financial relief to seniors.
“The sheer cost of these medications is a huge barrier to access,” Dr. Oz remarked during a call with reporters. “That ends today.”
Dr. Oz further elaborated that CMS intends to meticulously track participation and outcomes. This will help determine the most effective approach for the future, whether through an extension of the Bridge program or an alternative solution. He noted that while permanent legislative coverage is not an immediate necessity, it is a matter for Congress to consider.
“We can’t decide what’s going to happen long term with Bridge until we see some of the data,” he explained, mentioning ongoing discussions with pharmaceutical companies to further reduce costs.
A potential concern highlighted by Dr. Micah Eimer, a clinical assistant professor of cardiology at the Northwestern University Feinberg School of Medicine, is the increased susceptibility of older patients to adverse medication effects. He noted that their research indicates older patients on blood pressure medications are more prone to experiencing hypotensive side effects, such as fainting and dizziness, after initiating a GLP-1 medication.
