Key Takeaways:
Medicare will begin covering GLP-1 obesity drugs for the first time on July 1 through a temporary program that caps patient costs at $50 a month, unlocking access for millions of older Americans to treatments from Novo Nordisk and Eli Lilly.
The 18-month pilot, called the Medicare GLP-1 Bridge program, runs through Dec. 31, 2027, and covers Novo Nordisk's Wegovy and Eli Lilly's Zepbound KwikPen and Foundayo pill. Patients must have Medicare Part D coverage and meet body-mass index thresholds — a BMI of 35 or higher, or a BMI of 30 with conditions such as heart failure or uncontrolled hypertension, or a BMI of 27 with prediabetes or prior cardiovascular events.
"It's certainly good news for Medicare beneficiaries who have been essentially shut out of the market for GLP-1s for weight loss if they wanted to use insurance coverage," Juliette Cubanski, vice president and director of Medicare policy at KFF, said. "However, it is a temporary program. It is not a permanent change in Medicare coverage."
The $50 copay is a fraction of the drugs' list prices — Wegovy's wholesale cost is $1,349 a month — and well below the roughly $350 that cash-paying patients often pay. The government secured a $245 monthly price from Novo Nordisk and Eli Lilly. About 13.7 million Medicare beneficiaries have obesity or are overweight, according to KFF estimates, and 9 percent of adults 65 and older already use GLP-1s, mostly for diabetes.
The program operates outside standard Medicare Part D coverage, meaning the $50 copay does not count toward patients' deductibles or the $2,100 annual out-of-pocket cap. CMS selected Humana to handle prior authorization requests, which the agency expects to process within 24 to 72 hours. The Bridge program exists because federal law prohibits Medicare from covering weight-loss drugs long-term, so the Trump administration used its authority to run a temporary demonstration project.
The program's temporary nature creates uncertainty for patients who start treatment. Clinical trial data show patients typically regain weight after stopping GLP-1s, and no permanent coverage path exists beyond 2027. A planned follow-up program called BALANCE, which would have shifted costs to Medicare plans, was delayed after not enough insurers opted in.
"This is essentially all additional spending by the federal government," Cubanski said, estimating the program could add $4 billion to $5 billion a year to Medicare's tab. Medicare already spent $27.5 billion on GLP-1 drugs in 2024, before manufacturer rebates.
The Bridge program gives Novo Nordisk and Eli Lilly access to a new patient population at a time when some large employers are pulling back coverage. About 6 percent of large employers plan to drop GLP-1 weight-loss coverage in 2026, according to a Mercer survey published June 11, and another 5 percent plan to do so in 2027.
Patients who start GLP-1s through the Bridge program face a potential cliff at the end of 2027 unless Congress changes the law or CMS extends the pilot. The Congressional Budget Office estimated that broader Medicare coverage of obesity drugs could cost $35 billion over eight years, with 12 million newly eligible people in 2026 under more generous criteria than the Bridge program uses.
This article is for informational purposes only and does not constitute investment advice.
