Medicare to cover GLP-1 drugs for weight loss for the first time starting July 1. Here’s what to know.

Medicare patients will soon have access to GLP-1 medications for weight loss through a new program called Medicare GLP-1 Bridge, starting on July 1. This program aims to make these drugs more affordable by only requiring a $50 monthly copay. The medications included in this program are Zepbound, Foundayo, and Wegovy, manufactured by Eli Lilly and Novo Nordisk.

Juliette Cubanski, vice president and director of Medicare policy at the health care research nonprofit KFF, explained that this program is taking advantage of a specific section of the law that allows the federal government to establish a temporary program. This marks the first time Medicare will assist in covering drugs prescribed solely for obesity, rather than limiting coverage to other conditions like diabetes or cardiovascular disease.

The coverage under the Bridge program will run from July 1, 2026, to December 31, 2027. After this trial period, patients may lose access to Medicare coverage for GLP-1s used for weight loss unless there is an extension issued by the Centers for Medicare & Medicaid Services or a change in the law by Congress. It is also possible that drug manufacturers may adjust their pricing to match the $50 copay.

To be eligible for this program, Medicare beneficiaries with Part D coverage must be enrolled in an eligible plan. Providers must submit a prior authorization request showing that the patient is being prescribed a GLP-1 for weight loss and meet certain clinical criteria related to their BMI and health conditions.

The medications covered by Medicare in this program include Eli Lilly’s Foundayo and Zepbound KwikPen, as well as Novo Nordisk’s Wegovy in injection and pill form. Patients who meet the eligibility requirements will have to pay a $50 monthly copay, which does not count towards their deductible or yearly out-of-pocket cap. Coupons or discounts cannot be applied to further reduce the price.

Overall, this program provides Medicare patients with more affordable access to GLP-1 medications for weight loss, offering a new option for those seeking to manage their obesity.