We're Just Weeks Away From $50 Monthly GLP-1 Coverage for Medicare Beneficiaries. Here's What You Need to Know.
Key Points
Medicare is launching a new GLP-1 Bridge program scheduled to last through 2027.
This would give qualifying Medicare beneficiaries access to select GLP-1s for $50 per month.
You must have a qualifying health insurance plan, a prescription, and meet certain health criteria to be eligible.
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Ever since GLP-1s started getting attention as weight loss drugs, interested seniors have been forced to choose between their weight and their pocketbooks. Medicare currently covers the drugs only for the treatment of specific health conditions, like type 2 diabetes. But that is about to change.
Beginning July 1, Medicare is launching a new GLP-1 Bridge program that will give qualifying beneficiaries access to approved GLP-1s for weight loss for just $50 per month. Here's what you need to know if you'd like to take advantage of this opportunity.
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How the GLP-1 Bridge program will work
The GLP-1 Bridge program will run from July 1, 2026, through Dec. 31, 2027. It will enable Medicare beneficiaries to obtain these medications for weight loss, provided they meet certain criteria.
First, you must have a Medicare Part D prescription drug plan or a Medicare Advantage plan with prescription drug coverage. If you don't have one of these, then you won't be eligible for the program.
You'll obviously need a prescription, and you'll need your doctor to submit a prior authorization request to Medicare on your behalf. They can do this electronically or via fax.
Under the current rules, only a handful of GLP-1s will be covered:
- Foundayo
- Wegovy (injection and tablets)
- Zepbound (KwikPen only)
There are also health criteria you must meet to qualify. Those with a body mass index (BMI) under 27 will not be able to participate in the GLP-1 Bridge program. Those with BMIs between 27 and 34 may be eligible, depending on what other health conditions they have.
What to do if you're not eligible for the GLP-1 Bridge program
Contact the Centers for Medicare & Medicaid Services if you're not sure whether you qualify for the GLP-1 Bridge program. If you don't, you'll have to find another way to pay for these medications.
If you have other insurance, check whether your insurance would cover it. Or look into coupons from sites like GoodRx. It doesn't hurt to contact the drug manufacturer, too, to see if it has assistance programs available for low-income households or seniors. Even modest savings could reduce your retirement healthcare costs.
It's unclear what will happen to Medicare's GLP-1 coverage after 2027, so this is something to keep an eye on, too. If coverage expands, you may be able to get your GLP-1s through Medicare in the future.
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