Medicare changes coverage for GLP-1 weight loss drugs

Date:

play

Medicare has postponed a program for older Americans that would have required participating insurers to cover GLP-1 weight loss drugs such as Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound.

That doesn’t mean those on Medicare can live without these popular weight loss drugs. Medicare plans to offer GLP-1 weight loss drugs through the Bridge Program from July 1, 2026 to December 31, 2027, according to a Centers for Medicare and Medicaid Services (CMS) spokesperson.

The bridge program will allow people enrolled in Medicare, the federal health program for adults 65 and older, to obtain weight-loss drugs at prices negotiated under the most-favored-nation agreements signed by President Donald Trump with Eli Lilly and Novo Nordisk.

Lilly and Nordisk officials said Medicare enrollees will pay a $50 monthly copayment to obtain the drug.

The change will allow Medicare beneficiaries to access certain GLP-1 drugs “outside the scope of benefits and payment flows of Medicare Part D,” CMS said.

The change comes after multiple insurers expressed concerns about the voluntary BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive Health) program, which requires Part D insurers to cover medications. Insurers had until April 20 to commit to participating in the program.

CVS Health, which owns Aetna, said it has chosen not to participate in the BALANCE program. During UnitedHealth’s April 21 earnings call, company officials cited “notable challenges and unanswered questions” regarding the program.

CMS announced the BALANCE program in late 2025 as a way for Medicare and state Medicaid plans to circumvent the ban on coverage of weight loss treatments. The BALANCE program would also have charged Medicare enrollees a $50 monthly copayment to obtain weight loss drugs.

At the time, CMS Administrator Mehmet Oz said BALANCE would “expand access and lower prices for obesity treatment GLP-1 without passing the bill to taxpayers.”

CMS said states will continue accepting applications for the Medicaid portion of the BALANCE program until July 31, 2026. Medicaid is jointly funded by the federal government and the states, which directly administer their Medicaid programs under federal guidance.

Lilly, which sells the popular GLP-1 injectable weight loss drug Zepbound and the weight loss drug Foundayo, praised CMS’ decision to launch the bridge program amid uncertainty for insurers.

A Lilly spokesperson said the company “advocates a long-term vision for the BALANCE model,” but added that the bridge program will reach patients who would benefit from GLP-1 drugs.

A Novo spokesperson said the company supports the Bridge program while working on long-term access for older Americans.

While extending the bridge program through 2027 will ease uncertainty around reimbursement for weight loss drugs and blunt the short-term impact on demand, the indefinite delay clouds the long-term outlook for permanent integration into the Medicare prescription drug plan, analysts said.

Longer term, “we think that once this obesity benefit is established, it will be practical and politically difficult to remove it beyond 2028,” JPMorgan analyst Chris Schott said, according to Reuters.

Contributed by: Reuters

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Share post:

Subscribe

spot_imgspot_img

Popular

More like this
Related

Does Tucker Carlson still support Donald Trump? Explaining their aftermath

Tucker Carlson apologizes for helping elect President TrumpTucker Carlson...

Chemical leak in West Virginia kills 2, injures 21

A chemical leak at a West Virginia factory on...

What did AOC say to RFK? What you need to know in the seemingly heated exchange

Haley Stevens impeached for interrogation of RFK Jr.Rep. Haley...

You can now schedule a pickup time for your order in the Starbucks app

Facts about America's iconic brand StarbucksStarbucks has shaped the...