An expert explains how the new program, which launches July 1, will work and who is eligible

NEED TO KNOW

Key Takeaways

• A new Medicare pilot program will offer GLP-1 weight-loss medications for $50 a month starting July 1
• The program, which runs for 18 months, covers over 14 million eligible beneficiaries who have been diagnosed as obese or overweight
• Learn more about what to expect, who qualifies and how to maximize the benefits from a medical expert

Beginning July 1, millions of Americans on Medicare will have access to GLP-1 weight-loss drugs for just $50 a month.

Under the new pilot program, known as the Medicare GLP-1 Bridge, more than 14 million people enrolled in Medicare who have been diagnosed as obese or overweight could qualify for the discounted drugs.

Previously, Medicare—the federal insurance program for people aged 65 and older and for those younger with certain disabilities — “only covered these drugs for type 2 diabetes or cardiovascular disease, not for obesity,” says Dr. Sohaib Imtiaz, People Inc.’s chief medical officer. “The fact that they're starting to cover obesity is a big deal. When these GLP-1s launched, because of the pricing, a lot of people got left behind. This starts to equalize that.”

For now, however, the program is only short-term. Coverage will be available for 18 months, through the end of December 2027, at which time a follow-up program is expected — but not yet guaranteed — to launch.

Dr. Imtiaz explains how the new Medicare bridge program works and who is eligible.

What medications will be available?

The GLP-1s covered under the program are: Wegovy (injectible and oral versions); Zepbound (specifically the KwikPen); and oral medication Foundayo. “These medications are expensive and when it comes to obesity and weight loss, they haven't been covered well by insurance,” says Dr. Imtiaz. “People who qualify will only pay $50 a month for the medications, which is a dramatic reduction from the list prices we see now, which can be $1,000 per month.” And under the program, the $50 co-payment under the program would remain the same no matter the dose of the medication. 

Who is eligible?

Medicare beneficiaries who are enrolled in Medicare Part D and who are diagnosed with obesity (defined as having a BMI of 35 or more) will be covered and those who are overweight (BMI of 27 or more) and who have a secondary health condition like heart disease or prediabetes.

What do you need to do to get started?

Your healthcare provider needs to submit a prior authorization form. “The program starts on July 1st, so start talking to your physician early,” Imtiaz says. “See if you're eligible and see if they're knowledgeable about it. Also check with your insurance, check what plan you're on with Medicare and make sure that's aligned.”

This is a short-term program. Might people be reluctant to start these drugs knowing the program will end in 18 months?

“The data shows when people come off GLP-1 medications, a lot of people do end up gaining weight. Part of the reason for that is because they aren't doing resistance training or an exercise program. They haven't changed their lifestyle habits. When they go off the medication, the food noise comes back, and they feel hungry again and they start overeating and rebound. So yes, that's a worry for people. Obviously if they're on this program, their appetite's controlled, and then they come off, and they can't afford the medication anymore, they may gain the weight back. But that's why one key part of this program is that for a physician to approve this, they're looking at people who will also change their exercise and their nutrition. If you do that, you're a lot less susceptible to gaining the weight back."

What does a program like this say about how the thinking on obesity has changed?

“For too long, we've seen obesity as this lifestyle choice. But we know it's hormones and genetics and so much broader than that. And I think this indicates a culture and policy shift, and a recognition that GLP-1s are serious medical tools, not just cosmetic ones. It's reframing accessibility.”

How much of a need is there for this among the population that relies on Medicare?

“I think it's really important. Obesity ends up becoming a downstream problem — it causes many different conditions like diabetes, sleep apnea, heart conditions. This provides those people with the ability to start to lose weight and get some momentum, which often people struggle with. And it enables them to make behavioral changes so they're well for longer.”

Why use federal dollars to subsidize weight-loss medication? Why not look at lowering the cost for healthier foods or finding ways to lower stress instead?

“I'm a board-certified lifestyle medicine physician. Throughout my medical training, a lot of what I did was look at weight loss using nutrition, exercise, sleep, stress management support, the root causes, because they are drivers of obesity. But a lot of people who've tried diet, nutrition, exercise still rebound, they will yo-yo. There's hormonal factors at play: your appetite, your genetics, if your parents are obese, you're more likely to be obese. Other factors sometimes make it difficult for people to lose weight. They may feel more hungry than others. Metabolism may be slower. Everyone doesn't have an equal starting point. Giving people access to healthy food and reducing stress should be done, but that can take a lot longer for us as a society to fix. And you can't force people to take healthier action. The way GLP-1s act on the body and reduce hunger, we’ve seen it’s more of a sure way of reducing obesity compared to lifestyle interventions alone. But lifestyle absolutely is important to be healthy long-term.”

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