Medicare (temporarily) covers GLP-1s starting tomorrow
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Link copied by Joseph Choi and Nathaniel Weixel - 06/30/26 6:49 PM ET Link copied NOW PLAYING 96 Click in for more news from The Hill{beacon} The Trump administration’s temporary program to cover GLP-1 medications for obesity starts tomorrow and runs through 2027, but we still don’t know for sure how much it will cost taxpayers. Medicare is prohibited by law from covering weight-loss drugs but the Centers for Medicare and Medicaid Services is allowed to test new payment models under short-term pilot programs. Eli Lilly and Novo Nordisk agreed to a monthly $245 price for their respective GLP-1 drugs, and in exchange will have access to a new pool of eligible Medicare beneficiaries. Those beneficiaries will only pay $50 a month, but it won’t count towards their Part D deductible. Notably however, the program will only cover GLP-1 drugs for obesity, not for diabetes or any other indication. Chris Klomp, director of Medicare at CMS, recently stated the agency anticipates the program will start with “single-digit millions” of beneficiaries. According to a new estimate from KFF, an estimated 3.8 million beneficiaries could be eligible for Bridge as of 2023 data, based on meeting all the eligibility criteria. Those with a body mass index, or BMI, of 35 or more qualify.
Those with a BMI between 30 and 35 must also have one of the following: uncontrolled high blood pressure, prediabetes, a previous heart attack or stroke, blocked arteries in arms or legs with symptoms, chronic kidney disease at Stage 3a or higher or diastolic heart failure. Patients also must go through a prior authorization process to be approved. Once the program ends in 2027, it’s not clear what will happen.
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