Who qualifies for Medicare’s new weight loss drug program and which GLP-1s are included?
Zepbound is considered one of the most powerful options, leading to an average weight reduction of nearly 21 percent body weight after 72 weeks (Reuters)
Millions of Americans enrolled in Medicare now have access to GLP-1 weight loss drugs for $50 a month through a temporary pilot program known as the Medicare GLP-1 Bridge.
Novo Nordisk’s Wegovy in injection or pill form and Eli Lilly’s Zepbound four-dose KwikPen injection and Foundayo pill will be available for the low monthly fee through the end of 2027. The program will not cover single-dose Zepbound vials or pens medications.
Eligibility is extended to Medicare Part D enrollees whose health is at risk due to obesity, prediabetes, or a history of heart problems, but excludes individuals with existing GLP-1 coverage.
To obtain the drugs, patients need a doctor’s prescription, completion of a prior authorization process, and certification from their provider that the GLP-1 drug is part of a lifestyle program emphasizing diet and exercise.
The program, operating under federal authority to run a temporary “demonstration” project due to existing laws prohibiting Medicare coverage of these drugs, is valid through December 31, 2027, with its long-term future and patient access post-expiration currently unclear.
