Medicare will start covering weight-loss drugs this summer - here's what you need to know
Pilot test will run through 2027
A new Medicare program launching this summer could put GLP-1 weight-loss drugs within reach for millions of seniors for the first time. The catch: it’s a temporary pilot program with an uncertain outlook after 2027.
Medicare announced last week that a pilot program providing access to some GLP-1 drugs for obesity will begin July 1, with a very low patient co-payment of $50 per month. Medicare Part D already covers some GLP-1 medications for conditions such as diabetes, cardiovascular disease and sleep apnea; now, this program will be available for certain GLP-1 drugs approved for weight loss.
The expansion could significantly increase access to anti-obesity GLP-1 drugs among Medicare beneficiaries. About 40% of the 70 million people enrolled in Medicare meet the clinical definition of obesity, Centers for Disease Control and Prevention data shows. And the $50 monthly price is much lower than Medicare patients currently pay out of pocket for GLP-1 drugs covered under Part D for treatment of conditions other than obesity.
The pilot program - known as the Medicare GLP-1 Bridge - will run through the end of 2027. The Centers for Medicare & Medicaid Services has not yet announced plans to restart or restructure its longer-term plan to integrate coverage into Part D after that date.
There are some odd twists to the way this coverage is coming online. You must be enrolled in a Part D or Medicare Advantage program to to receive coverage - but this will not be part of your plan. There’s also no assistance for low-income seniors at this point, because the coverage is outside normal drug coverage. Finally, if the weight-loss coverage does move into Part in 2028, the out-of-pocket costs are almost certain to be higher than the $50 pilot co-pay.
My latest article for the New York Times takes a look at what Medicare beneficiaries seeking coverage need to know about how the pilot program will work, who is eligible, and how coverage might continue after the pilot period ends. There’s also a useful F.A.Q. page on the Medicare website.
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