Participants in the Medicare GLP-1 Bridge program will be able to receive a GLP-1 — Foundayo, Zepbound or Wegovy (above) — at a copay of $50 per month.
The federal government is rolling out a new program that will enable some Medicare recipients to access GLP-1 weight loss medications for $50 per month.
The U.S. Centers for Medicare and Medicaid Services launched the pilot program, called the Medicare GLP-1 Bridge, on July 1.
Medicare is the federal program that typically provides health care coverage to older adults, although some younger adults are also covered. For the new GLP-1 program, though, not everyone on Medicare is eligible.
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Here’s what to know about the new program and who can participate.
What is the Medicare GLP-1 Bridge?
The Medicare GLP-1 Bridge is a pilot program that aims to provide GLP-1s — the megapopular weight loss medications — to a select group of people who are enrolled in Medicare Part D. (Part D is the drug coverage portion of the Medicare program.)
The pilot program, which launched Wednesday, is slated to run until the end of 2027.
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Who’s eligible for the pilot program?
There are a handful of eligibility requirements for people interested in receiving GLP-1s under the Bridge rollout.
First, in order to participate, you must have Medicare drug (Part D) coverage, and you must not already have coverage for a GLP-1. That means that people with diabetes, for instance, are not eligible for the program, but may be able to access the medications through other drug coverage.
In order to participate in the pilot program, you must also fall into one of the three following categories:
- Have a BMI of 35 or greater
- Have a BMI between 30 and 35, along with one or more of the following: heart failure, hypertension, chronic kidney disease, prediabetes, a previous heart attack, peripheral artery disease
- Have a BMI between 27 and 30, along with one or more of the following: prediabetes, a previous heart attack, peripheral artery disease
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The Medicare website has a page dedicated to the Bridge program, with additional details on the health qualifications.
How many people will be eligible?
It’s difficult to say exactly how many people may be eligible to participate in the new program.
The research and policy arm of the organization KFF analyzed the data based on 2023 Medicare information. That analysis found that about 3.8 million people may be eligible for the Bridge rollout.
KFF also pointed to comments from Medicare director Chris Klomp, who said the feds expect that the Bridge program will start out with beneficiaries numbering in the “single-digit millions.”
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How much do GLP-1s cost under the program?
Participants in the Bridge program will be able to receive a GLP-1 — Foundayo, Wegovy or Zepbound — at a copay of $50 per month.
That copay has restrictions, including that it won’t count toward your deductible, because the program is outside of the established Medicare framework.
I think I’m eligible. How do I enroll in the program?
Accessing GLP-1s under the new program starts with a visit with a medical provider.
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For people who are eligible, a healthcare provider will need to send in a prescription and complete a prior authorization form.
Those who are successfully covered, the Medicare website says, will receive a confirmation letter in the mail. That prior authorization will then remain valid until the end of 2027.
For more information on the Medicare GLP-1 Bridge, you can visit the Medicare website, where you can walk through a series of questions to determine eligibility. You can also have a conversation with your medical provider, or call Medicare at 1-800-MEDICARE.