Medicare to cover GLP-1 drugs for weight loss starting July 1. Here's what to know.

Key Points:

• Starting July 1, Medicare will launch the GLP-1 Bridge pilot program, allowing some beneficiaries to access GLP-1 weight-loss medications for a $50 monthly copay, marking the first time Medicare covers these drugs solely for obesity treatment.
• The program covers Eli Lilly’s Foundayo and Zepbound, as well as Novo Nordisk’s Wegovy, and runs from July 1, 2026, to December 31, 2027, with uncertain continuation beyond that period unless extended by CMS or Congress.
• Eligibility requires Medicare Part D enrollment in an eligible plan, prior authorization from providers, and meeting specific BMI and health criteria; approximately 3.8 million Medicare beneficiaries are estimated to qualify.
• The $50 copay does not count toward Medicare deductibles or the annual out-of-pocket spending cap, and patients cannot use coupons or discounts to lower the cost further.
• Patients currently prescribed GLP-1s for conditions like Type 2 diabetes or sleep apnea under Medicare Part D are not eligible for this program, emphasizing the need for beneficiaries to consult their clinicians about eligibility.