Medicare launches pilot program to cover GLP-1 weight-loss drugs with $50 copay
Starting July 1, Medicare will offer an 18-month pilot that pays for certain GLP-1 medications prescribed for obesity, requiring a $50 monthly copay for eligible beneficiaries.
Medicare will begin an 18-month pilot program on July 1 that provides coverage for GLP-1 drugs prescribed solely for weight loss, with a $50 monthly copay for qualifying beneficiaries. The initiative, called Medicare GLP-1 Bridge, includes Eli Lilly’s Foundayo and Zepbound KwikPen and Novo Nordisk’s Wegovy in both injection and pill forms.
"Medicare is not changing the law right now," said Juliette Cubanski, vice president and director of Medicare policy at the health-care research nonprofit KFF. "What it's doing is taking advantage of a specific section of the law that gives the federal government the ability to stand up a temporary program."
Eligibility is limited to Medicare Part D enrollees whose providers obtain prior authorization and confirm that patients meet clinical criteria based on body-mass index and related health conditions. Approximately 3.8 million beneficiaries are expected to qualify. Patients already receiving GLP-1 therapy for diabetes or sleep apnea are excluded.
The program runs through December 31, 2027; continuation beyond that date would require an extension by the Centers for Medicare & Medicaid Services or legislative action. The $50 copay does not count toward the standard deductible or the $2,100 annual out-of-pocket maximum, and coupons or discounts are prohibited.
"The good news is they don't have to meet their deductible in order to qualify for the $50 copay," Cubanski added. "But on the other hand, the $50 copay doesn't count towards their $2,100 out-of-pocket cap."