The drugs covered under the program include Wegovy tablets and injections, Zepbound KwikPens, and Foundayo tablets
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The Centers for Medicare & Medicaid Services will give eligible Medicare beneficiaries access to certain weight loss drugs for $50 a month as part of a pilot program that begins Wednesday — the first time Medicare has covered the medications for weight loss in the program's history.
The Medicare GLP-1 Bridge runs until Dec. 31, 2027, and requires participants to carry a Medicare Part D prescription drug plan. Notably, the $50 monthly charge is structured outside standard benefit accounting. It neither reduces a beneficiary's annual deductible nor counts toward the out-of-pocket maximum, CNN reported.
The drugs covered under the program include Wegovy tablets and injections, Zepbound KwikPens, and Foundayo tablets. Getting into the program requires active effort: after meeting eligibility requirements, a beneficiary must secure a doctor's prescription and clear a prior authorization review by CMS before any coverage kicks in.
Eligibility is broad but carries restrictions. Automatic eligibility applies to anyone whose body mass index reaches 35 or above. For seniors whose BMI falls in the 30-to-34 range, at least one additional health condition is required — qualifying diagnoses include uncontrolled high blood pressure, prediabetes, a prior cardiac event such as a heart attack or stroke, or chronic kidney disease, CNN reported. Seniors who are already getting GLP-1 medications paid for by their Part D insurer — because those drugs were prescribed for type 2 diabetes or another condition Medicare already covers — fall outside the Bridge program's eligibility boundaries.
CMS Administrator Dr. Mehmet Oz said in a statement that high costs have prevented too many seniors from accessing the treatments. "The Medicare GLP-1 Bridge changes that by making these medications more affordable and accessible," he said.
Where standard Part D benefits flow through private insurance companies, the Bridge program bypasses that structure entirely, with CMS itself running the coverage directly. CMS uses a single central processor to handle prior authorization, claims processing, and payment to pharmacies, the agency said. Because the program runs outside the standard Part D benefit structure, private Part D plans do not need to opt in for their enrollees to be eligible.
Awareness of the new coverage remains low. Data from the Obesity Care Advocacy Network paint a striking picture of how little word has spread: a poll of more than 2,100 people aged 65 and up, fielded in late March, showed that eight in ten seniors had no idea Medicare coverage for obesity drugs was on the way, CNBC reported. An agency official explained the muted rollout campaign to CNBC by saying that seniors tend to engage most with a benefit once it exists rather than before it arrives, which shaped CMS's decision to hold back on broad advertising before launch.
The Bridge was conceived as a short-term, six-month bridge to a longer insurer-led pilot called the Balance model, under which Part D plans would have assumed responsibility for coverage. When voluntary sign-ups for Balance fell short of what was needed, CMS stretched the Bridge to run through the end of 2027, CNN reported.
A growing number of large employers are dropping GLP-1 coverage for weight loss heading into 2027, driven by climbing overall health care costs, even as per-unit drug prices have fallen. For seniors caught in that gap, the Bridge program offers meaningful relief: without insurance, the same medications carry cash prices that vary from roughly $149 to $449 each month based on which drug and dose a patient takes.
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