Medicare (temporarily) covers GLP-1s starting tomorrow

Temporary Medicare GLP-1 coverage begins tomorrow 

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........

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