Medicare Starts Pilot to Cover Select GLP-1 Drugs for Eligible Beneficiaries
Medicare will launch a limited "GLP-1 Bridge Program" next month, offering coverage for Wegovy, Zepbound and Foundayo to qualifying enrollees through the end of 2027.
Medicare announced a pilot "GLP-1 Bridge Program" that will begin next month, extending Part D coverage to certain GLP-1 medications for eligible beneficiaries. The demonstration, which will run until Dec. 31, 2027, includes Wegovy, Zepbound and Foundayo.
Eligibility requires participants to be 18 or older and meet specific health criteria, such as a body-mass index (BMI) of 35 or higher, or a BMI of 30 or higher combined with conditions like heart failure, uncontrolled hypertension or chronic kidney disease. Individuals with a BMI of 27 or higher may also qualify if they face risks of prediabetes, heart attack or peripheral artery disease.
A centralized system will manage approvals, claims and pharmacy payments, and enrolled patients will pay a fixed monthly copayment of $50 for the drugs.
"Federal law has generally barred Medicare from covering drugs prescribed specifically for weight loss, but Part D plans can cover these medications when prescribed for other approved conditions," the Medicare Rights Center noted.