BySuzanne Blake
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More than 600,000 Medicare beneficiaries have signed up for GLP-1 weight-loss medications in the first two months of a new federal program that caps patient costs at $50 per month, Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz said Monday
These obesity treatments have historically been out of reach for many seniors because of their high price tags
“The biggest thing this program is doing for seniors is turning access to these drugs from a potentially enormous expense into a predictable $50 monthly decision,” Michael Ryan, a finance expert and the founder of MichaelRyanMoney.com, told Newsweek. “Getting 600,000 people enrolled in just two months tells you there was substantial demand.”
Why It Matters
GLP-1 medications such as Wegovy and Zepbound have transformed obesity treatment in recent years, but their high costs have limited access for many Americans, including for retirees living on fixed incomes
Before the new program, patients often faced out-of-pocket expenses that could exceed $1,000 per month
But the new enrollment figures suggest there’s strong demand among older Americans for low-cost GLP-1s, potentially impacting Medicare’s healthcare costs in the long run
…
What To Know
On Monday, Oz said approximately 600,000 seniors have already enrolled in the Medicare GLP-1 Bridge program during its first two months. The initiative launched on July 1 and is scheduled to run through December 31, 2027
Under the program, eligible beneficiaries can receive covered GLP-1 medications for a flat $50 monthly copayment
The program covers select GLP-1 medications, including Wegovy, Eli Lilly’s Zepbound in its KwikPen form, and Foundayo, an oral GLP-1 treatment.However, the program is temporary
“The long term issue is what happens after people build their health and household budgets around that access. This isn’t permanent coverage,” Ryan said
“If Medicare ultimately incorporates comparable GLP-1 coverage into Part D, the Bridge may prove to be exactly what its name suggests. A temporary path to something more durable. If it doesn’t, seniors who became accustomed to paying $50 could suddenly face much higher costs or difficult coverage decisions.”
What Is the Medicare GLP-1 Bridge Program?
The Medicare GLP-1 Bridge is a temporary CMS program created to expand access to obesity medications for eligible Medicare beneficiaries
The agency announced the initiative in May, positioning it as a way to provide innovative but costly treatments at a predictable monthly cost while evaluating how broader coverage could affect health outcomes and Medicare spending
“These treatments are a major medical advancement, but too many seniors are currently unable to access them due to high cost,” Oz said at the time. “The Medicare GLP-1 Bridge changes that by making these medications more affordable and accessible, while advancing our broader goal of helping Americans live healthier lives.”
At the program’s launch, CMS said beneficiaries who qualify would be able to obtain covered medications for $50 per month regardless of income level, with the program set to be available through the end of 2027
“GLP-1s can be life-changing for patients managing obesity and related conditions,” said Chris Klomp, director of Medicare and Chief Counselor at the U.S. Department of Health and Human Services, in a statement. “This demonstration is designed to make accessing those medications simpler, more predictable, and more consistent across the Medicare program, which means better quality of life for seniors and better value across the health care system.”
Who Qualifies?
According to Medicare guidance, beneficiaries generally must have Medicare Part D prescription drug coverage and meet specific clinical criteria
Eligibility is based on body mass index (BMI) thresholds and certain medical conditions.Medicare says patients may qualify if they:
- Have a BMI of 35 or higher.
- Have a BMI of 30 or higher and certain qualifying health conditions.
- Have a BMI of 27 or higher along with specific cardiovascular disease histories or prediabetes.
However, some beneficiaries are excluded from the Bridge program because they may already qualify for GLP-1 coverage through traditional Medicare Part D
According to Medicare guidance, people with Type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease should instead seek coverage through their existing drug plans
Kevin Thompson, the CEO of 9i Capital Group and the host of the 9innings podcast, warned that the high participation rate in the program could end up having unintended consequences for U.S. healthcare
“If more seniors sign up for these drugs for weight loss, it could cause supply disruptions for those with chronic illnesses for which the drugs were originally designed, even while helping others lose weight,” Thompson told Newsweek
What Happens Next
The Medicare GLP-1 Bridge program is authorized through December 31, 2027
After that, the program’s future remains uncertain, and CMS will likely use data gathered during the pilot to evaluate whether broader Medicare coverage of obesity medications should continue or be modified
With enrollment already reaching 600,000 beneficiaries after only two months, the costs and health outcomes will likely be used to assess the program’s impact on both patients and Medicare spending
“We won’t know the long-term impacts until much later, as these drugs were never designed to be used by such a large population, but rather by a smaller sample of those with diabetes. The real issue is what happens if and when the program ends,” Thompson said
He added that many patients end up gaining weight right back after stopping the medication, and there are potential digestive side effects
“Ultimately, we are expanding the use of these drugs at a massive scale, and we may not fully understand the long-term consequences for years,” Thompson said
Contact Newsweek editors on this story:Jason LemonandGray R. Thomas
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