By Dr. Shelia Spann
On July 1, for the first time, Medicare began covering certain GLP-1 medications specifically for weight loss for eligible beneficiaries. The new Medicare GLP-1 Bridge Program will run through December 31, 2027.
The program includes:
- Foundayo tablets
- Wegovy injection or tablet
- Zepbound (Kwik pen only)
The single-dose Zepbound pen and Zepbound vials are not covered.
Approximately 42 percent of seniors 65 years or older are classified as obese. The Bridge Program will expand access to medications that were previously out of reach for many older Americans.
There are more than 69 million Medicare beneficiaries, and several million are expected to access the drugs through the Bridge Program, said Chris Klomp, deputy administrator of the Centers for Medicare and Medicaid Services. Approximately 15-20 million older adults in Medicare are estimated to qualify for weight-loss drugs, according to pharmaceutical companies Novo Nordisk and Eli Lilly.
Medicare Part D, or prescription drug plans, already covered some GLP-1s for conditions like diabetes and cardiovascular disease, but federal law has banned coverage solely for obesity. The Bridge Program sidesteps that law to cover the drug for obesity for more beneficiaries, including those who are overweight with conditions like prediabetes or uncontrolled hypertension.
For eligible people, the program offers these medications for $50 per month, no matter your income level. This $50 payment doesn’t count toward your Medicare Drug Plan deductible or yearly out-of-pocket limit. These drugs are not eligible for the Medicare Prescription Payment Plan.
To meet the criteria, one of the following must be true:
- You have a Body Mass Index (BMI) of 35 or higher.
- Your BMI is 30 or higher, and you have certain types of heart failure or high blood pressure that’s hard to control or chronic kidney disease (stage 3 or above).
- Your BMI is 27 or higher, and you have prediabetes, or you’ve had a heart attack, stroke, or blocked arteries in your legs or arms.
BMI is a number your doctor calculates based on your height and weight. Ask your doctor what your BMI is if you don’t know.
How to apply:
- Make an appointment with your doctor or other healthcare provider to see if you qualify for the Medicare GLP-1 Bridge for Weight Management.
- If you’re eligible, your provider must send a prescription for a covered GLP-1 drug to the pharmacy and, when requested, complete a prior authorization. Your provider must certify that you’re using the GLP-1 drug as part of a lifestyle program that focuses on diet and exercise.
Your pharmacy may ask for your Medicare number or the last four digits of your Social Security number to help them process the prescription.
Visit Medicare.gov or call 1-800-Medicare (1-800-633-4227) for more information about Medicare GLP-1 Bridge.
Dr. Shelia Spann, PharmD, CDCES, is a pharmacist, diabetes educator, licensed broker for Medicare and life insurance, and executive director of Diabetes Solutions and Wellness. The mission of the organization is to provide quality education in self-managing diabetes and health and life insurance needs.
