A New Medicare Option for Weight Loss Drugs: What Older Americans Should Know
Starting in July, Medicare beneficiaries will be able to get a GLP-1 prescription for weight loss for $50 per month. This is a notable change for Medicare, which has long been barred from covering weight loss treatments.
Medications, such as Wegovy and Zepbound, are effective but can be expensive without insurance coverage. They are available in injection or pill form. Even with discounts, current spot prices generally range from $149 to $699 per month.
According to a KFF survey, about half of GLP-1 users say it was difficult for them to obtain the drugs. A quarter said it was “very difficult” to pay them.
But the new Medicare benefit comes with caveats, particularly around clinical guidelines and what happens at the end of the short-term program.
What is this program?
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 to December 31, 2027. It aims to “bridge” the gap before a longer-term program which may – or may not – begin in 2028.
The pilot program will provide coverage for the following GLP-1 medications approved for weight loss: Wegovy’s Pill and injectable formulations, Zepbound’s KwikPen formulation, and Foundayo Pill.
Who can participate?
To access these weight loss medications, you must be enrolled in a Medicare Part D plan, which covers prescription drugs. After that, eligibility depends mainly on body weight and health status. People will be eligible if they have a body mass index of 27 or higher and have a condition such as heart disease or prediabetes, among others. People with a BMI of 35 or more are automatically eligible. About 40% of American adults are clinically obese, with a BMI of 30 or more, according to the Centers for Disease Control and Prevention.
How the program works (it’s a bit unusual)
This is not your typical Medicare benefit. Although 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 managed by CMS contractor Humana, using a system already in place for another Medicare drug program. Physicians do not need to be enrolled as a Medicare provider to write a prescription or submit a prior authorization request under this program. Once approved, patients will pay the flat $50 co-payment to the pharmacy when they pick up the prescription.
What are the advantages?
The savings could make these drugs accessible to patients who simply could not afford them before. Even with discounts, prices can be intimidating without insurance coverage. TrumpRx, a new government website, provides links to direct discounts on prescription drugs for patients not using their health insurance. On this site, the price of Wegovy injectable products ranges from $199 for a lower dose for the first two months to $399 for a higher dose. Zepbound’s KwikPen formulation costs up to $699 per month. At the highest doses, the Wegovy daily pill costs up to $299, while Foundayo tops out at $349.
Most people who use these medications will need a higher dose to maintain their weight loss. The Bridge program is unique in that it offers a predictable $50 copay that does not increase as doses increase.
What are the disadvantages?
As with many pilot programs, there are tradeoffs. The $50 copayment will not count toward the Part D deductible, nor the $2,100 annual cap on prescription drug costs. The pilot program will also end in December 2027. Most studies have shown that many people who stop taking the GLP-1 drugs regain the weight they lost while taking them.
Still obstacles for low-income people
If you receive the Low Income Subsidy, also known as the Medicare Extra Help program, you cannot use this assistance for medications covered by the GLP-1 Bridge program. For beneficiaries accustomed to paying a $5 or $10 copayment for their pharmaceuticals, a $50 copayment could still pose a significant financial barrier.
“Fifty dollars a month seems like a good deal compared to the discounted prices through TrumpRx and these other direct-to-consumer options, but it’s a lot of money for someone living on a Social Security check of $750 a month,” said Juliette Cubanski, deputy program director on health insurance policy at KFF, a nonprofit health information organization that includes KFF Health News.
The $50 co-pay is for weight loss only
If you are already taking one of these medications for a qualifying condition such as type 2 diabetes, cardiovascular disease risk reduction, or sleep apnea, you will continue to receive it through your regular Part D plan. This means you’ll pay the price of your plan, which may be more than the $50 bridging copay, meaning the same medication may cost different amounts depending on what it’s prescribed for.
If you are already taking a GLP-1 for weight loss, you may be eligible for the Bridge program. Your prescriber will need to certify that you met the clinical criteria when you started taking the medication. For example, if you started GLP-1 treatment in September 2024 with a BMI of 37 but by July 2026 you lost weight and now have a BMI of 34, the prescriber must certify in the prior authorization request that you met the criteria for a BMI of 35 or greater at the start of GLP-1 treatment.
What will happen after 2027?
The Trump administration had proposed a two-step approach to expanding GLP-1 coverage for obesity in Medicare. The Bridge program was initially scheduled to last six months. After that, the idea was to launch a longer-term program that would shift the cost of drugs from the government to insurers. A recent study found that the long-term program would have cost insurance companies billions of dollars in the first year. Not enough insurers signed on to the voluntary plan before 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 on Medicare are receiving GLP-1 drugs during the Bridge program and more time to negotiate with the Trump administration.
But expanding the Bridge program will be “very expensive” for Medicare, Cubanski said, because the program heavily subsidizes drug costs.
“There is currently no idea how much the Bridge model will cost, but it will likely be billions of dollars in additional spending per year for Medicare,” Cubanski said.
The cost to Medicare will largely depend on how many people use the Bridge program. CMS has not provided any projections publicly, but a previous KFF analysis estimated that in 2020, nearly 14 million Medicare beneficiaries were overweight or obese.
“It will just cost additional money, and we don’t know how much, because they haven’t disclosed it,” Cubanski said.
Are you a Medicare recipient and want to get a GLP-1 for weight loss? Is a $50 copay manageable? Click here to contact the KFF Health News reporting team.
