Millions of older adults could be eligible for GLP-1 weight loss drugs under a recently launched Medicare pilot program.
The Medicare GLP-1 Bridge Program, launched July 1 by the Centers for Medicare and Medicaid Services, allows enrollees to qualify for weight-loss drug prescriptions based on height, weight and other criteria and pay only a $50 monthly copayment.
The bridge program is a major change because Medicare, the federal health program that primarily covers adults 65 and older, prohibits coverage of weight loss drugs containing GLP-1.
Who is eligible?
According to the CMS website, to qualify for the Medicare GLP-1 Bridge Program, a beneficiary must:
- You have prescription drug coverage under Medicare, known as Medicare Part D.
- Be over 18 years old
- You have a specific body mass index (BMI), which is a measure of your height and weight.
- Request drugs aimed at weight loss in combination with lifestyle modifications such as structured nutrition and physical activity.
Depending on a person’s BMI, certain conditions such as prediabetes, hypertension, and chronic kidney disease may also be considered.
You must also obtain a prescription from a physician or other licensed prescriber, and prior authorization is required.
The Medicare GLP-1 Bridge is “designed to increase access to GLP-1 for beneficiaries who seek the drug solely to lose excess weight or maintain weight loss,” the CMS website states, adding that other indications such as type 2 diabetes and sleep apnea are also not covered by the program.
How long will the Medicare GLP-1 Bridge Program be in place?
This bridge program will run until the end of 2027. It’s unclear what will happen after this period, but for now, the program could help adults access popular medications that can cost more than $1,000 at list price and aren’t necessarily covered by insurance.
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 the health policy nonprofit KFF.
Contributor: Ken Alltucker, USA TODAY
