Medicare Announces GLP-1 Weight Loss Medication Pilot Program

Medicare is set to introduce a pilot program in July that aims to make certain GLP-1 weight loss medications more accessible to beneficiaries for $50 per month. Historically, Medicare has not covered weight loss treatments, so this initiative, called the Medicare GLP-1 Bridge, marks a significant change. Set to run from July 2026 to December 2027, it aims to provide interim support until more permanent measures can be implemented in 2028.

The program will cover specific medications, including both pill and injectable versions of Wegovy, the KwikPen version of Zepbound, and the Foundayo pill. Eligibility depends on enrollment in a Medicare Part D plan and specific health metrics, such as a body mass index (BMI) of 27 or higher accompanied by conditions like heart disease or prediabetes. Individuals with a BMI of 35 or more automatically qualify.

Unlike standard processes, the Bridge program involves AI-driven prior authorization through a centralized system managed by CMS contractor Humana. Any doctor, regardless of Medicare provider status, can prescribe the medication and initiate the authorization. Once approved, beneficiaries will pay a consistent $50 copayment for their prescriptions.

However, the program has limitations. The $50 copay does not count toward the Part D deductible and is not included in the $2,100 annual out-of-pocket cap on drug costs. Additionally, those benefiting from the Medicare Extra Help program, which offers reduced costs to low-income individuals, are excluded. Challenges loom as many who cease using GLP-1 medications may regain lost weight, an issue to address once the pilot concludes.

Should the Bridge program end, beneficiaries using these medications for non-weight loss conditions will continue to access them through standard Part D processes, potentially at higher costs. Originally, the Bridge program was intended to precede a comprehensive plan transferring drug costs from Medicare to insurance carriers. However, limited insurer participation has extended the pilot's duration to late 2027.

Juliette Cubanski from KFF notes that despite the financial burden on Medicare, the program's longevity is vital for evaluating usage data and negotiating future terms. As of now, Medicare has not released uptake or cost projections for the pilot, but previous KFF analyses highlight the high prevalence of overweight and obese individuals among Medicare beneficiaries. For more information, stakeholders can consult resources from the Centers for Medicare & Medicaid Services.