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Under a recently launched Medicare pilot program, millions of older adults may qualify for GLP-1 weight loss drugs.
The Medicare GLP-1 Bridge program, which the Centers for Medicare & Medicaid Services launched on July 1, allows enrollees to qualify for prescription weight loss medication based on height, weight and other criteria − and only pay a monthly $50 copay.
The bridge program is a significant change because Medicare, the federal health program mainly for adults 65 and older, has been prohibited from covering weight loss medications, including GLP-1s.
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Who is eligible?
To qualify for the Medicare GLP-1 Bridge program, according to the CMS website, a beneficiary must:
- Have prescription drug coverage under Medicare, known as Medicare Part D
- Be at least 18
- Have a certain BMI, or body mass index, a measure of height and weight.
- Be requesting the drug for weight loss in combination with lifestyle modifications including structured nutrition and physical activity.
Depending on a person's BMI, certain conditions like pre-diabetes, high blood pressure, chronic kidney disease and more may also be considered.
People must also get a prescription from a doctor or other licensed prescriber, and they will be subject to prior authorization.
The Medicare GLP-1 Bridge was "designed to increase access to GLP-1s for beneficiaries who seek the drug solely to reduce excess body weight or maintain weight reduction," the CMS website notes, adding other indications, like Type 2 diabetes and sleep apnea, are eligible for coverage outside of this program.
How long will the Medicare GLP-1 Bridge program run?
The bridge program will run through the end of 2027. It is unclear what will happen after this time, but for now, the program could help adults access the popular medications, which can exceed $1,000 in list price and aren't always covered by insurance.
Although drugmakers have cut prices for cash-paying customers, more than half of adults on GLP-1s say the drugs have been difficult to afford, according to KFF, a health policy nonprofit.
Contributing: Ken Alltucker, USA TODAY
This article originally appeared on USA TODAY: Everything you need to know about Medicare coverage for GLP-1s
