President Trump announces price cuts for GLP-1 drugs Zepbound, Wegovy
President Donald Trump announced discounted pricing for Zepbound and Wegovy and expanded Medicare coverage to give more people access to the drugs.
Millions of seniors will soon be eligible for popular GLP-1 weight loss drugs like Wegovy and Zepbound under the Medicare pilot program.
On July 1, the Centers for Medicare and Medicaid Services will launch the Medicare GLP-1 Bridge Program for enrollees who qualify for prescription weight loss drugs based on height, weight, and other criteria. Seniors receiving weight loss drugs pay a $50 monthly co-pay, with Medicare covering the rest of the cost.
The bridge program is a major change since Medicare, the federal health program that primarily covers adults 65 and older, prohibits coverage of weight loss drugs containing GLP-1. The bridge program will run until the end of 2027.
The program could help seniors afford popular medications that many people want, even though the list price can exceed $1,000 and insurance coverage is uncertain. Although drug companies have lowered prices for cash-paying customers, more than half of adults taking GLP-1 say the drug is difficult to obtain, according to KFF, a nonprofit health policy group.
KFF said 9% of adults 65 and older use GLP-1, but usage among younger people is slightly higher.
Medicare’s bridge program comes as companies that provide health insurance to most working-age adults are cutting coverage. About 6% of large employers plan to discontinue coverage of GLP-1 weight loss drugs in 2026, and another 5% plan to discontinue coverage in 2027, according to a study released June 11 by consultant Mercer. Nearly half of large employers will have weight loss drug coverage by 2025.
Raymond Brown, head of North American clinical pharmacy at Mercer, said “costs continue to rise” for employees paying insurance benefits.
If employers don’t want to remove coverage for popular and expensive medications, they may add additional requirements for workers, such as regularly contacting a weight loss coach to obtain GLP-1 regularly.
Employers are asking, “Can we keep these costs under control?” Mr. Brown said.
Who is eligible for Medicare GLP-1 coverage?
Medicare beneficiaries must have prescription drug insurance, known as Part D, to be eligible for medication. People must obtain prescriptions from a doctor or other licensed prescriber, and prior authorization is required.
Not everyone can participate in the program. Eligibility for anti-obesity drugs should be based on body mass index, a measure of height and weight. Typically, people with a BMI of 35 or higher are eligible. Some people with a BMI of 27 or higher may qualify if they have other medical conditions, such as prediabetes or peripheral artery disease.
Medicare beneficiaries who are already receiving GLP-1 drugs for type 2 diabetes, sleep apnea, or heart disease risk will not receive the drugs under the bridge program. They will continue to obtain their medications through their regular Part D prescription drug coverage.
Although a Part D plan is required for Medicare beneficiaries to qualify for GLP-1 under the Bridge Program, the private insurance companies that administer Part D plans are not involved in the Bridge Program. Medicare processes authorizations, processes claims and pays pharmacies, according to the Medicare Rights Center.
Medicare has not released an estimate of how many Americans will be eligible to receive anti-obesity drugs under the Bridge Program.
Based on 2020 data, KFF estimated that approximately 13.7 million Medicare beneficiaries are obese or overweight.
Which drugs are covered by Medicare?
Novo Nordisk’s Wegoby is sold as a shot and pill and is eligible for the Bridge Program. KwikPen’s version of Eli Lilly’s injectable drug Zepbpound and the drug company’s weight loss drug Foundayo qualify for the bridge program.
Novo and Lilly are trying to outdo each other with lower prices for cash-paying customers whose insurance plans don’t cover the drug.
Novo previously lowered the price of its injectable drug Wegovy and most doses of its diabetes drug Ozempic from $499 per month to $349 per month for consumers who purchase the drug directly from drug companies, telemedicine partners or retail pharmacies.
Lilly also previously announced price reductions for consumers who purchase Zepbound directly.
