Medicare launches pilot GLP-1 discount program with eligibility restrictions

Medicare has launched an 18-month pilot program, the Medicare GLP-1 Bridge program, offering weight loss medications like Wegovy and Zepbound for $50 a month to eligible Part D enrollees. However, the program excludes patients who have other conditions that GLP-1s are FDA-approved to treat, such as Type 2 diabetes or sleep apnea, routing them back to standard Part D plans with high copays. KFF estimates the pilot could cost between $3.3 billion and $10 billion depending on enrollment.

Medicare GLP-1 Bridge pilot program

• ▪Prior authorization requests for the Medicare GLP-1 Bridge program are submitted to a contractor-run system for the Centers for Medicare & Medicaid Services rather than the patient's Part D insurer
• ▪The Medicare GLP-1 Bridge program is designed to evaluate whether offering coverage for weight loss medications will save Medicare money in the long term
• ▪In July 2026, Medicare launched an 18-month pilot program called the Medicare GLP-1 Bridge program to offer GLP-1 medications for weight loss to certain enrollees for $50 a month
• ▪The Medicare GLP-1 Bridge program covers three medications: Wegovy, the KwikPen formulation of Zepbound, and the oral medication Foundayo

Bridge program eligibility restrictions

• ▪Patients with conditions that the Food and Drug Administration has approved GLP-1s to treat, such as Type 2 diabetes or moderate to severe obstructive sleep apnea, are excluded from the Medicare GLP-1 Bridge program's $50 price
• ▪Patients with a body mass index of 27 to 34 can qualify for the Medicare GLP-1 Bridge program if they also have certain health conditions like prediabetes or cardiovascular disease
• ▪The $50 monthly price under the Medicare GLP-1 Bridge program applies only to individuals using the drugs solely for weight loss
• ▪To qualify for the Medicare GLP-1 Bridge program, patients must be enrolled in Medicare Part D and generally have a body mass index of 35 or higher

Medicare Part D coverage gaps

• ▪Federal law prohibits Medicare from covering prescription drugs that are prescribed solely for weight loss
• ▪Almost all Medicare Part D plans require prior authorization for GLP-1 medications, and some require patients to undergo step therapy before receiving approval
• ▪Patients excluded from the Medicare GLP-1 Bridge program due to having other treatable conditions are routed back to their Medicare Part D plans, which can require copays of hundreds of dollars

Patient affordability barriers

• ▪Primary care physician Taylor Lacy stated that the Medicare GLP-1 Bridge program leaves behind patients with the greatest medical need by excluding those with other qualifying diagnoses
• ▪Medicare patients who do not qualify for the Medicare GLP-1 Bridge program face GLP-1 copays ranging from $200 to $600 or more per month under their standard insurance
• ▪Approximately one in five American adults has taken a GLP-1 medication, and the majority report that the drugs are difficult to afford

Program cost estimates

• ▪Juliette Cubanski of KFF estimated that the Medicare GLP-1 Bridge program costs could reach $10 billion if three-quarters of eligible patients enroll
• ▪Juliette Cubanski of KFF estimated that the Medicare GLP-1 Bridge program will cost Medicare $3.3 billion if one-quarter of eligible patients enroll and remain on treatment for 18 months
• ▪Juliette Cubanski of KFF estimated that 3.8 million people qualify for the Medicare GLP-1 Bridge program

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