Medicare obesity drug GLP-1 coverage starting July 1

Key Points:

• Starting July 1, millions of Medicare beneficiaries will gain access to obesity drugs (GLP-1s) through the new Bridge demonstration program, paying a $50 monthly copay, a significant reduction from typical out-of-pocket costs.
• The Bridge program temporarily bypasses federal law banning Medicare coverage solely for obesity, covering patients with BMI ≥35 or lower BMI with related conditions like prediabetes or cardiovascular issues, with eligibility verified via prior authorization.
• The program may face challenges including potential surges in demand straining clinics and pharmacies, a cumbersome prior authorization process, and limited public awareness, potentially causing delays in patient access.
• Novo Nordisk and Eli Lilly stand to benefit from expanded patient access, with analysts projecting rapid adoption and significant revenue growth, especially given seniors’ preference for oral obesity drugs.
• Coverage under Bridge is temporary, set to expire at the end of 2027, with uncertain long-term access unless federal law changes or private insurers agree to continue coverage, raising concerns about treatment continuity for patients requiring lifelong therapy.