Medicare will start covering weight-loss drugs on July 1 for the first time. Here’s what you need to know

Key Points:

• Starting July 1, millions of Medicare enrollees will gain access to weight-loss drugs for the first time under the temporary Medicare GLP-1 Bridge pilot program, offering medications like Wegovy and Zepbound at a reduced copay of $50 per month.
• Eligibility is limited to certain Medicare Part D enrollees meeting specific BMI and health criteria, excluding those with type 2 diabetes or already receiving GLP-1 drugs through Medicare; enrollment requires prior authorization from a doctor.
• The pilot program, running through the end of 2027, aims to be cost-neutral for Medicare by potentially reducing overall healthcare costs due to improved beneficiary health, with drugmakers Eli Lilly and Novo Nordisk providing discounted pricing to Medicare.
• While the program is expected to benefit millions initially, uncertainties remain about total enrollment, long-term insurer participation, and whether coverage will continue beyond the pilot, as voluntary insurer involvement has been limited.
• Patient advocates and doctors emphasize the program’s significance in recognizing obesity as a treatable disease and improving access to affordable medications, though some eligible seniors remain confused about criteria and affordability challenges persist.