Medicare GLP-1 Bridge: New Coverage for Weight Loss Drugs

As of this week, certain Medicare and Medicare Advantage beneficiaries are eligible to receive select GLP-1 agonists for weight loss through a federal program known as Medicare GLP-1 Bridge. Participants can access these medications at a cost of $50 per month under a pilot initiative running until the end of 2027. This program marks a significant advancement, allowing coverage for GLP-1 medications for weight reduction in older adults, subject to specific weight and health criteria.

Mehmet Oz, MD, leading the Centers for Medicare & Medicaid Services (CMS), expressed hopes that the program will aid in collecting valuable data to shape future insurance coverage, while offering financial relief to eligible seniors. Dr. Oz highlights the financial burden of these medications, emphasizing that the ongoing data collection will inform future coverage decisions.

Eligible participants include Medicare beneficiaries with a BMI of 35 or higher or a BMI of 27 coupled with another health condition, as outlined by CMS guidelines. Conditions considered include prediabetes and a history of heart attack or stroke. Eligibility is determined by the initial BMI recorded at the start of GLP-1 therapy.

Juliette Cubanski, PhD, MPH, from the healthcare policy research organization KFF, points out that while millions of Medicare enrollees face weight management challenges, the program serves a narrower segment. The covered medications include Eli Lilly’s orforglipron (Foundayo) and tirzepatide (Zepbound), along with Novo Nordisk’s semaglutide (Wegovy).

Future long-term coverage for these medications remains uncertain since current federal legislation does not authorize Medicare to permanently cover weight-loss drugs. While Congress might legislate to change this, CMS is exploring additional pilot programs such as BALANCE, which has been delayed due to insurer hesitation.

Oz confirmed CMS’s intention to monitor the program's engagement and outcomes closely, ready to make necessary adjustments. Discussions with the Associated Press underscored that a permanent legislative solution is a topic for congressional deliberation. This initiative offers transformative possibilities for beneficiaries but highlights ongoing challenges in healthcare affordability and accessibility.