What to know about Medicare's $50 GLP-1 program

Key Points:

• Starting June 28, Medicare and Medicare Advantage beneficiaries meeting specific health criteria can access certain brand-name GLP-1 weight loss drugs for $50 a month through the new Medicare GLP-1 Bridge trial, running until the end of 2027.
• Eligibility requires a BMI of 35 or higher, or a BMI of 27 or higher with an additional health condition such as prior heart attack, stroke, or prediabetes; those with diabetes, sleep apnea, or fatty liver disease are excluded from this program but may have coverage under other Medicare provisions.
• Covered medications include Eli Lilly’s Foundayo and Zepbound, and Novo Nordisk’s Wegovy, all FDA-approved for weight loss; the $50 monthly cost is subsidized by Medicare and does not count toward insurance deductibles or out-of-pocket maximums.
• The program aims to collect data on participation and outcomes to inform potential longer-term coverage decisions, but permanent Medicare coverage of weight loss drugs requires Congressional action and remains uncertain.
• While the program offers significant financial relief for some older adults struggling with obesity, others may find eligibility criteria restrictive or remain unable to afford these medications, highlighting ongoing access challenges.