The drugs were previously available through Medicare for conditions like diabetes, but will now be available for weight loss.
Up to 14 million Medicare recipients are overweight and could qualify for the discounted drug program — known as the Medicare GLP-1 Bridge — which rolls out July 1 and continues through 2027.to drastically lower drug costs for Americans, with the president striking a deal with some of the leading GLP-1 makers to provide the drugs at a low “most favored nation” rate.
Ozempic retails for more than $1,000 a month, and the weight-loss variant of the drug, Wegovy, is listed for $1,350. There are some work-arounds to save money, but no cheap generic versions because they are still new medications under patent. That makes the GLP-1 Bridge program a rare opportunity for people to get their hands on the weight-loss drugs at a small fraction of the usual price.
GLP-1 prescriptions were previously available for Medicare patients dealing with conditions like diabetes, sleep apnea, and cardiovascular disease — but were not available for weight loss, the treatment that’s made headlines as patients shed dozens of pounds on the drug. This program is a short-term pilot to gauge the feasibility of a larger program — accounting for the “Bridge” part of the title. The Bridge program runs from July 1, 2026, to Dec. 31, 2027.
It remains unclear if it will continue after 2027, as the Bridge program’s purpose is to see how much demand there will be for GLP-1s so insurance companies can gauge whether they will participate. Insurer participation is vital to make a long-term GLP-1 weight-loss Medicare program feasible, as the government would depend on them to subsidize the costs of the huge of the GLP-1s discounts.
The government would be on the hook for billions of dollars if insurers don’t sign up, with the Congressional Budget Office estimating the program would cost taxpayers about $35 billion from just 2026 to 2034, Such a cost could prevent a long-term program from being affordable — especially as the federal government looks to tamp down on entitlement spending. Most Medicare patients 65 years and older who are overweight qualify for the program.
That means you must have a body mass index of 35 to automatically qualify, or a BMI of 27 and an obesity-associated condition like pre-diabetes and heart disease,If you are already taking a GLP-1 through Medicare for another condition, you may not qualify for the $50 copay. Foundayo and Wegovy are available as pill, rather than injectables. Ozempic, which is primary used to treat diabetes and not for weight loss, is not part of the program.
Wegovy, a pill, costs between $199 and $399 per month. The drugs are from the makers Eli Lilly and Novo Nordisk, which were central to President Trump’s “most favored nation” deal. Patients will not go through their usual Medicare Part D program to obtain GLP-1 prescriptions through the Bridge program. Instead, they must obtain a prior-authorization from a doctor who will submit that paperwork through the platform Humana.
Patients will then be able to fill their prescriptions at a pharmacy, where they will only have to pay the program’s $50 co-pay. The Bridge program provides deals only on the weight-loss drugs — none of the counseling that typically accompanies somebody trying to shed serious pounds to improve their health, With the Bridge program providing weight-loss drugs for people older 65, that could become problematic for patients who lose too much weight but don’t have accompanying treatment and counseling.
Making a meaningful difference in health also requires more than just a drug — nutrition, diet and exercise are required to keep pounds off and stay healthy, doctors say. Most GLP-1 users also typically gain weight back when they stop taking the drug unless they’ve made significant changes to their lifestyle in tandem — so if the Bridge program does not continue after it ends in 2027, that could have health consequences for patients.
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