Medicare GLP-1 Bridge program for weight loss

• The Medicare GLP-1 Bridge benefit provides coverage for people with obesity for $50 per month through the end of 2027.
• Meet the BMI requirements; the program does not cover medications for obesity if you have a BMI below the threshold, including diabetes or other conditions.
• Medications include Wegovy, Zepbound, and Foundayo; the next step is to determine what medical coverage is available.

For those with obesity, the federal Medicare GLP-1 Bridge program is designed to cover the cost of weight-loss medications priced at $50 per month for certain Medicare beneficiaries enrolled in Medicare Advantage. Timelines for the program vary by country and end in 2027.

To qualify, you must meet eligibility requirements for Medicare Part D, which includes having a BMI of 35 or higher, or a BMI of 27 or higher with at least one weight-related condition, as specified by CMS. BMI requirements may vary by country, and the program may change based on CMS guidelines.

The program does not cover the medications if you have not met the requirements. It is possible to cover other medications through Medicare Part D after diagnosis.

For the CMS, the following are the tablet forms of the drugs: Foundayo from Eli Lilly, Zepbound from Eli Lilly in KwikPens, and Wegovy from Novo Nordisk in tablet form. The program covers up to $50 per month without any additional costs, and the patient will not pay more than that, as long as the prescription is filled through Medicare.

For CMS, this refers to the first step. The program covers only the preparation of the drugs.

According to CNN, the uncertainty is that the program will not be extended due to the high risk of misuse. However, the program is still expected to be available until the end of 2027.

CMS Administrator Center for Medicare & Medicaid Services has announced that the program will help reduce the cost of weight-loss medications. The program is expected to continue until the end of 2027.

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