Medicare to Offer Cheaper GLP-1 Weight Loss Medications to Seniors

Medicare will offer cheaper GLP-1 weight loss medications to seniors through a new pilot program, covering drugs like Ozempic and Wegovy for $50 a month

A group of weight loss medications on a white background. Photograph: UCG/Universal Images Group/Getty Images

For Kathryn, a 66-year-old retiree from Denver, Colorado, taking a GLP-1 weight loss medication has been a game-changer. She started taking Semaglutide, a type of GLP-1 medication about two years ago and was able to break the cycle of cyclical weight loss and gain that had plagued her for years. At her heaviest, Kathryn weighed 220lbs, but she now weighs 133lbs and has seen significant improvements in her blood pressure and cholesterol levels.

What is the Medicare GLP-1 Bridge program?

However, the cost of Semaglutide, a type of GLP-1 medication, which can be as high as $450 per month, has been a significant burden for Kathryn. She has had to stretch out her dosages to make each order last longer than a month, and has had to put off traveling in retirement due to the expense. But with the launch of a new pilot program on July 1, some Medicare recipients like Kathryn will be able to access GLP-1 weight loss medications for $50 a month.

The Medicare GLP-1 Bridge program will cover three drugs - Foundayo, Wegovy, and Zepbound - and be available to people who have Medicare Part D, an optional extra coverage to lower the cost of prescriptions. To be eligible, participants must have a body mass index of 35 or higher, and cannot have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease.

How will the program affect the healthcare system?

Doctors who treat obesity say the initiative could help millions of older adults who struggle to pay for the drugs or cannot afford to start taking them. Dr. Annie Moore, an internist at CU Health in Denver, notes that the program is a significant step forward, but questions remain about the federal government's administration of the program. "It's a huge social and healthcare experiment to have this volume of people that are going to rely on the CMS website working; the pharmacy side working and the health system side all being able to process these prior authorizations in an efficient, effective way," she said.

Despite the potential benefits of the program, there are concerns about the impact on the healthcare system. Dr. Christopher Weber, an internist in Milwaukee who only sees patients struggling with obesity, notes that the program will be a challenge for clinics, which will have to process a large number of prior authorizations. "If millions more people want to start taking a GLP-1, the clinics are going to be busy," he said.

The Bridge program is slated to run until the end of 2027, prompting providers to raise concerns about what will happen if the government does not extend it. Obesity is a chronic condition, and patients typically regain the weight they lost after stopping a GLP-1. "It's a temporary program; obesity is not a temporary problem," said Dorothea Vafiadis, a senior strategist for healthy aging at the National Council on Aging.

For now, physicians such as Moore and Weber hope the program will allow more patients to start taking a GLP-1. Weber said that he talks with at least five patients each day who could benefit from such a drug but cannot afford it. Carmin, a healthcare worker from Denver, is one such patient. She has been interested in trying a GLP-1 but opted not to because she is saving for retirement. Now, she hopes to use the Bridge program to get back into clothes she was wearing two years ago.