Medicare launches temporary coverage for obesity drugs with $50 copay
A new Medicare demonstration program will pay for GLP-1 obesity medications for eligible seniors at a $50 monthly copayment, but the coverage is set to expire in 2027.
Starting July 1, Medicare’s Bridge demonstration program will cover GLP-1 drugs for obesity for beneficiaries who meet specific weight-related criteria, charging a flat $50 monthly copayment that does not count toward the Part D deductible or out-of-pocket cap. The initiative, funded by federal dollars and administered by Humana, aims to serve "several million" seniors, according to CMS deputy administrator Chris Klomp, and could open the market to millions of new patients for Novo Nordisk and Eli Lilly.
Eligibility requires a body-mass index of 35 or higher, or a lower BMI with conditions such as prediabetes, prior heart attack, stroke, or peripheral artery disease. Providers must submit prior-authorization requests, which CMS says will be processed within 72 hours, though some clinicians warn the paperwork could strain already busy clinics and pharmacies.
"It's good news that Medicare is rolling out this program, but it is temporary, so it's really not clear at this point what happens after the end of the 18-month program duration," said Juliette Cubanski, director of the Program on Medicare Policy at KFF.
The $50 copay is markedly lower than the $199-$699 monthly prices patients typically pay out of pocket for the same drugs. Researchers note that many seniors may still struggle with the added cost, given that a quarter of Medicare beneficiaries earned less than $24,600 in 2024.
Industry analysts expect the program to boost prescription volumes for both companies, with some projecting over $1 billion in annual revenue for each, though no firm forecasts have been released. The coverage is set to end in 2027 unless Congress passes the Treat and Reduce Obesity Act or private insurers adopt a permanent solution.
"We’re going to carefully track participation and outcomes in Bridge," a CMS official told reporters, emphasizing the need for data to inform future policy.
Experts caution that discontinuation of GLP-1 therapy could lead to weight regain, underscoring uncertainty for patients who start treatment under the temporary program.