New Medicare Option for Weight Loss Drugs: What Older Americans Should Know

New Medicare Option For Weight Loss Drugs News

New Medicare Option for Weight Loss Drugs: What Older Americans Should Know
What Older Americans Should Know

Starting in July, Medicare beneficiaries may be able to get a GLP-1 prescription for weight loss for $50 a month.

FRIDAY, May 8, 2026 — Starting in July, Medicare beneficiaries may be able to get a GLP-1 prescription for, such as Wegovy and Zepbound, are effective but can be expensive without insurance coverage.

They're available in injection or pill form. Even with discounts, current cash prices typically range from $149 to $699 per month. But the new Medicare benefit comes with caveats, particularly around clinical guidelines and what happens when the short-term program ends. The initiative, announced by the Centers for Medicare & Medicaid Services, is a short-term pilot program known as the Medicare GLP-1 Bridge .

It will run from July 1, 2026, through Dec. 31, 2027. It's meant to “bridge” the gap before a longer-term program that might — or might not — begin in 2028. To get access to these weight loss medications, you must be enrolled in a Medicare Part D plan, which covers prescription drugs. After that, eligibility is based mainly on body weight and health status.

People will qualify if they have a body mass index of 27 or higher and have a condition such as, among others. People with BMIs of 35 or higher automatically qualify. This is not your typical Medicare benefit.

Even though Part D enrollment is required, the Bridge program itself works differently. Instead of going through your regular Part D plan, you will need prior authorization. Your doctor will send the prescription to a central system run by CMS contractor Humana, using a system already in place for another Medicare drug program. Doctors don't need to be enrolled as Medicare providers to write a prescription or submit a prior authorization request under this program.

Once they get approval, patients will pay the flat $50 copayment at the pharmacy when they pick up the prescription. The cost savings could make these drugs accessible to patients who simply couldn't afford them before. Even with discounts, the prices can be daunting without insurance coverage. TrumpRx, a new government website, provides links to direct-to-consumer prescription drug discounts for patients not using their health insurance.

On that site, Wegovy injectables range in price from $199 for a lower dosage for the first two months to $399 for a higher dosage. The KwikPen formulation of Zepbound costs up to $699 per month. At the highest dosages, the daily Wegovy pill costs up to $299 while Foundayo tops out at $349. Most people who use these drugs will need a higher dose to maintain weight loss.

The Bridge program is unique in that it offers a predictable $50 copayment that does not go up as dosages increase. Like many pilot programs, there are trade-offs. The $50 copay will not count toward the Part D deductible, nor does it count toward the $2,100 annual out-of-pocket cap on prescription drug costs. The pilot program will also end in December 2027.

Most studies have shown that many people who stop using the GLP-1 drugs regain weight they lost while taking them. If you receive the low-income subsidy, also known as the Medicare Extra Help program, you cannot use that assistance for the drugs covered by the GLP-1 Bridge program. For beneficiaries accustomed to paying a $5 or $10 copay for their pharmaceuticals, a $50 copay could still be a big financial barrier.

“Fifty dollars a month sounds like a great deal compared to paying the discounted prices through TrumpRx and these other direct-to-consumer options, but it's a lot of money for somebody who's living on a $750-a-month Social Security check,” said Juliette Cubanski, deputy director of the Program on Medicare Policy at, you'll continue to get it through your regular Part D plan. That means you'll pay your plan's price, which may be higher than the $50 Bridge copay, meaning the same drug could cost different amounts depending on the reason it is prescribed.

If you're already on a GLP-1 for weight loss, you may qualify for the Bridge program. Your prescriber will need to attest that you met the clinical criteria when you first started the medication.

For example, if you started a GLP-1 in September 2024 with a BMI of 37 but in July 2026 you've lost weight and now have a BMI of 34, the prescriber should attest in the prior authorization request that you met the BMI criteria of 35 or over when the GLP-1 therapy started.in Medicare. The Bridge program was initially planned to last six months — after that, the idea was to launch a longer-term program that would shift the cost of the drugs from the government to insurers.

A recent study found the long-term program would have cost insurance companies billions of dollars in the first year. Not enough insurers signed on for the voluntary plan by the April deadline, so CMS instead announced it would extend the Bridge program to 18 months, with a new end date of December 2027.

The move will give insurance companies more data on how many people with Medicare get GLP-1 drugs during the Bridge program and more time to negotiate with the Trump administration. But extending the Bridge program will be “really expensive” for Medicare, Cubanski said, because the program heavily subsidizes the cost of the drugs.

“There's no sense right now of the cost of the Bridge model, but it is likely to be billions of dollars a year in additional spending for Medicare,” Cubanski said. The cost to Medicare will depend largely on how many people use the Bridge program.

CMS has not provided any projections publicly, but a previous“This will just cost additional money, and we don't know how much, because they haven't disclosed it,” Cubanski said.is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling and journalism. There are many reasons for sudden weight gain when there are no changes in diet or exercise. Learn to identify the cause of your sudden weight gain.

We have summarized this news so that you can read it quickly. If you are interested in the news, you can read the full text here. Read more:

MedicineNet /  🏆 575. in US

What Older Americans Should Know

 

United States Latest News, United States Headlines

Similar News:You can also read news stories similar to this one that we have collected from other news sources.

Medicare Data Exposed: How To Know if Social Security Number Was ImpactedMedicare Data Exposed: How To Know if Social Security Number Was ImpactedA publicly accessible Medicare database exposed Social Security numbers linked to health care providers.
Read more »

Many Medicare enrollees can get GLP-1 drugs for $50 starting in JulyMany Medicare enrollees can get GLP-1 drugs for $50 starting in JulyMedicare announced a pilot program for the popular drugs on Wednesday.
Read more »

Longtime San Jose State hangout starts a new chapter with new ownerLongtime San Jose State hangout starts a new chapter with new ownerPeanuts Deluxe Cafe owner Richard Hobbs wants to make the eatery a worker-owned business.
Read more »

Medicare scam targets seniors with fake genetic testing offersMedicare scam targets seniors with fake genetic testing offersSeniors across the country are being targeted by a growing Medicare scam that starts with a simple phone call.
Read more »



Render Time: 2026-05-08 23:51:00