About 600,000 seniors have signed up for discounted weight-loss drugs just two months after the Centers for Medicare and Medicaid Services launched a new coverage pathway
CMS Administrator Mehmet Oz shared the update in a White House policy announcement yesterday, adding that the so-called Medicare GLP-1 Bridge demonstration is on track to save the federal program, while improving seniors’ outcomes
“We project we’ll actually be able to save money for the taxpayer because the savings aren’t only in dollars, they’re in saved lives, less hospitalizations, less complications from high blood pressure, diabetes, and all the ravages of obesity because we got prices where they need to be,” Oz said
The Bridge demonstration provides eligible Medicare Part D beneficiaries with access to certain weight-loss medications for a flat $50 monthly copayment. This compares to $1,200 a month
Participation is just a fraction of those eligible, though. KFF projected ahead of Bridge’s July 1 launch that 3.8 million Medicare beneficiaries could be eligible during the demonstration’s run
Still, the demonstration has greatly expanded access to widely popular brand-name GLP-1s, which Medicare does not cover for weight management under federal law. Under Bridge, beneficiaries can get the Foundayo tablet, Wegovy injection or tablet or the Zepbound KwikPen. Treatment is based on beneficiaries’ body mass index alone if it is 35 or higher, or on BMI and preexisting conditions, such as hypertension and prediabetes, or prior medical events, such as a heart attack or stroke
GLP-1 prescribing among adults aged 65 years and older is up 19% from June to July 2026, when Bridge launched, according to a recent analysis from health data and analytics company Truveta. This marked the largest single month-to-month increase over more than seven years of data, researchers noted
Prescriptions for Zepbound and Wegovy were especially up among seniors by 80.1% and 40.9%, respectively, during the period, once again aligning with Bridge’s launch
The findings underscore how policy changes that reduce financial barriers can have immediate effects on medication access, the Truveta researchers explained. Although they recommended continued monitoring to determine whether these early changes persist
What’s ahead for Medicare GLP-1 coverage
And that’s what most payers are doing. Bridge is a temporary demonstration program to run through 2027, so the federal government can collect data on utilization and costs while expanding access to high-demand weight-loss drugs. The model also operates around Part D, but does not impact Part D sponsors
The demonstration was to act as an intermediary before the launch of the Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth, or BALANCE, Model. The model aims to lower the cost of weight-loss drugs while providing nutrition and fitness coaching to Medicare and Medicaid beneficiaries
However, the CMS nixed the Medicare portion of the BALANCE Model in April after lackluster interest from Part D plan sponsors, including leading payers like UnitedHealthcare. Coverage for state Medicaid programs has begun rolling out this spring, although Indiana is the only state so far to publicly announce its participation
Bridge will be a critical test of expanding access to GLP-1s for weight-management indications, as payers and state Medicaid programs await evidence on how broader access will affect spending. The Congressional Budget Office estimates $35.5 billion in additional federal spending between 2026 and 2034 if lawmakers allowed Medicare to cover weight-management indications of the drugs. There would also be limited healthcare savings from improved outcomes, with CBO estimating only about $1 billion through 2034.
These costs could overwhelm Part D budgets, analysts say
However, new research from Zepbound manufacturer Eli Lilly and Company shows that sustained use of the drug among older adults with obesity did, in fact, lower overall healthcare costs. Costs were up to 15% lower at six months and up to 38% lower by 12 months compared to patients not treated
“This analysis shows treatment costs can be lowered, and in some cases more than covered, by savings elsewhere in care — including for payers and in Medicare,” Ilya Yuffa, executive vice president and president of Lilly USA and Global Customer Capabilities, said in a statement. “As coverage expands across Medicare, states and employers, these data offer evidence on the cost implications of long-term obesity treatment and should help shape decisions.”
The CMS has not announced a new timeline or indicated when it will reschedule the Medicare portion of the BALANCE Model
Jacqueline LaPointe is an Executive Editor at Xtelligent Healthcare Media, covering revenue cycle management, healthcare payers, health policy and health IT since 2016
Dig Deeper on Healthcare member experience and engagement
Study: Bariatric surgery beats GLP-1s on long-term costs, outcomes
By: Jacqueline LaPointe3.8M qualify for Medicare GLP-1 Bridge at program’s July start
By: Jacqueline LaPointe
CVS brings back Lilly’s Zepbound coverage, adds obesity pill Foundayo
By: Alivia Kaylor, MScBoehringer’s dual agonist obesity drug spurs up to 16.6% weight loss
By: Alivia Kaylor, MSc
