SouthernWorldwide.com – Starting July 1, 2026, some Medicare beneficiaries will have access to GLP-1 medications for weight loss for the first time. A new pilot program, Medicare GLP-1 Bridge, aims to make these drugs more affordable with a $50 monthly copay.
This program expands coverage for weight-loss drugs from Eli Lilly and Novo Nordisk, including Zepbound, Foundayo, and Wegovy. Previously, Medicare only covered these GLP-1s for conditions like diabetes or cardiovascular disease.
Juliette Cubanski, vice president and director of Medicare policy at KFF, explained that Medicare is not changing existing law. Instead, it’s utilizing a provision that allows the government to establish a temporary program.
While drugmakers have reduced out-of-pocket costs recently, many patients still face monthly expenses around $350. The Medicare GLP-1 Bridge program will run for 18 months, from July 1, 2026, to December 31, 2027. After this period, coverage may cease unless extended by the Centers for Medicare & Medicaid Services or through legislative changes.
Who is Eligible for the Medicare GLP-1 Bridge Program?
Medicare beneficiaries with Part D coverage who are enrolled in an eligible plan can access this program. To be considered, a healthcare provider must submit a prior authorization request. This request needs to confirm that the GLP-1 medication is prescribed for weight loss.
The prior authorization process is crucial for the pharmacy to be able to fill the prescription. Providers also need to demonstrate that their patients meet specific clinical criteria related to their Body Mass Index (BMI) and existing health conditions when starting a GLP-1 drug.
These clinical criteria include having:
- A BMI of at least 35.
- A BMI of at least 30, coupled with a history of heart failure, uncontrolled hypertension, or chronic kidney disease.
- A BMI of at least 27, along with prediabetes, a prior heart attack or stroke, or symptomatic peripheral artery disease.
It’s important to note that patients already receiving Medicare Part D coverage for GLP-1s for conditions like Type 2 diabetes or sleep apnea are not eligible for coverage through the Bridge program. Cubanski advises interested patients to consult with their clinician to determine their eligibility.
What GLP-1 Drugs are Covered?
The Medicare GLP-1 Bridge program will cover several specific medications. These include Eli Lilly’s Foundayo, a daily oral weight loss pill, and Zepbound KwikPen, a weekly injectable weight loss medication.
Novo Nordisk’s Wegovy, available in both injection and pill forms, is also included in the covered medications. These drugs are specifically for weight loss under this new program.
Understanding the Costs and Copayments
Eligible Medicare recipients will be responsible for a $50 monthly copay for these GLP-1 drugs. However, there are important distinctions regarding how this copay functions. Since the program operates outside of standard Medicare Part D coverage, the $50 copay does not contribute to a patient’s deductible or their annual out-of-pocket maximum.
Cubanski highlighted that while beneficiaries do not need to meet their deductible to qualify for the $50 copay, this amount does not count towards their $2,100 out-of-pocket cap. Additionally, patients are prohibited from using coupons or manufacturer discounts to further reduce the cost of the medication.
The temporary nature of the program means that beneficiaries should be aware of the potential end of coverage after December 31, 2027. The future availability of Medicare coverage for GLP-1s for weight loss remains uncertain beyond this pilot phase.
