Medicare GLP-1 Bridge Program Offers Weight-Loss Drugs for $50
- mike33692
- 1 hour ago
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Medicare GLP-1 Bridge Program Offers Weight-Loss Drugs for $50 a Month
A new federal program is giving some Medicare beneficiaries access to prescription weight-loss medications for a flat $50 monthly copay, potentially reducing the cost of drugs that can otherwise cost hundreds of dollars each month.
The Medicare GLP-1 Bridge program began July 1 and is designed as a temporary pathway for eligible Medicare patients seeking certain GLP-1 weight-loss medications. The 18-month program is scheduled to continue through Dec. 31, 2027.
Medicare GLP-1 Bridge Program Covers Select Weight-Loss Drugs
The program is being administered by the Centers for Medicare & Medicaid Services and is available to qualifying beneficiaries enrolled in Medicare prescription drug coverage.
According to CMS, the demonstration is intended to expand access to certain GLP-1 medications for obesity while Medicare develops a longer-term approach to coverage.
Under the program, eligible patients pay $50 per month for covered GLP-1 medications, regardless of the prescribed dosage.
Covered medications include Wegovy, including eligible injectable and oral formulations, and certain formulations of Zepbound. Coverage depends on the specific medication and formulation approved through the program.
Patients should not assume that every medication commonly described as a GLP-1 is included.
For example, drugs such as Ozempic and Mounjaro may be covered through regular Medicare Part D benefits when prescribed for an FDA-approved condition such as Type 2 diabetes, but they are not automatically covered through the weight-loss bridge benefit.
Medicare beneficiaries can review the program's current covered-drug information through the official Medicare GLP-1 Bridge guide.
Who Qualifies for $50 GLP-1 Medications Through Medicare?
Not every Medicare beneficiary who wants a weight-loss prescription will qualify.
Patients must have Medicare Part D prescription drug coverage or a Medicare Advantage plan that includes prescription drug benefits.
Clinical eligibility also applies.
Generally, beneficiaries may qualify with a body mass index of 35 or higher, or with a BMI between 27 and 34 when they also have a qualifying weight-related health condition.
Those conditions can include issues such as high blood pressure, prediabetes or high cholesterol, depending on the program's clinical requirements.
People who already qualify to have a GLP-1 medication covered through their regular Medicare Part D benefits for another medical indication may not qualify for the separate bridge program.
Patients also do not enroll in the program simply by filling out an application.
A health care provider must determine whether the patient meets the clinical requirements, prescribe an eligible medication and submit the required prior authorization information.
Additional information about Medicare prescription drug coverage is available directly from Medicare.
What Medicare Patients Need to Know About the $50 Copay
The biggest difference for qualifying patients is the cost.
Instead of paying the retail price of a medication such as Wegovy or Zepbound, an approved beneficiary pays a flat $50 monthly copay for a medication covered by the demonstration.
However, the bridge program operates separately from normal Part D cost-sharing rules.
That means the $50 payments generally do not count toward a beneficiary's Part D deductible or annual out-of-pocket spending limit.
The program is also temporary.
Unless the federal government extends or changes the demonstration, the Medicare GLP-1 Bridge program ends Dec. 31, 2027.
For Oklahoma seniors interested in the program, the first step is talking with their physician or other qualified health care provider about whether they meet the medical criteria and whether one of the covered medications is appropriate.
The new benefit could make GLP-1 weight-loss drugs significantly more affordable for Medicare patients who previously had limited or no coverage for medications prescribed specifically for obesity.
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