Medicare Pilot Program Cuts GLP-1 Drug Costs to $50 a Month for Eligible Patients

Popular weight loss drugs have remained out of reach for most older Americans on Medicare for years. That's because GLP-1s can cost hundreds of dollars per month, but that changes this week. Starting Wednesday, millions of eligible Medicare patients can access GLP one obesity drugs from Novo Nordisk and Eli Lilly for a co-pay of just $50 per month. It's a major shift for a federal program that has traditionally barred coverage of medications prescribed solely for obesity. So what happened? Well, there's a new Medicare pilot program called bridge that's creating a temporary pathway for coverage. Patients who meet certain requirements, including those with a BMI of over 35,

and people with certain obesity related conditions, may now qualify for drugs that would otherwise cost hundreds of dollars per month out of pocket. The move could dramatically expand access and prevent costly complications tied to obesity. It also opens the door to potentially millions of new patients for Novo and Lilly. According to their estimates, it could be as many as 20 million. More than 69 million Americans are enrolled in Medicare, and officials expect several million beneficiaries to join the bridge program right off the bat. But the rollout may not be seamless.

Doctors must submit prior authorization requests to confirm that beneficiaries meet eligibility requirements before coverage is approved. Some physicians also worry that a wave of new patients could put additional pressure on already busy clinics and pharmacies. I do think we're all going to have to be a little bit patient, because there is probably going to be a bit of a strain on clinics and pharmacies for the next couple of months as people very excitedly start these medications. And there's a bigger issue.

The coverage isn't permanent unless the Trump administration extends or replaces the program. The obesity drug coverage through bridge is currently scheduled to expire by the end of 2027, and changing the law would require congressional approval. So the risk is that some patients will start these long term therapies without knowing whether they will still be covered a year and a half from now. So as Medicare opens the door to obesity drug coverage for millions of older Americans, the next challenge may be determining whether that access is here to stay.