Big Medicare change slashes weight-loss drug costs for eligible seniors
Millions of Medicare beneficiaries struggling with obesity could soon see the cost of weight-loss drugs plummet, as a new federal pilot program launching July 1 expands access to GLP-1 medications like Wegovy and Zepbound for eligible seniors.
Through a new trial called Medicare GLP-1 Bridge, the federal government is now offering a selection of the brand-name medications to certain Medicare and Medicare Advantage beneficiaries for $50 a month, The Associated Press reported.
The covered medications include drugmaker Eli Lilly’s Foundayo tablets and Zepbound KwikPens and Novo Nordisk’s Wegovy injections and tablets, all of which have been FDA-approved for weight loss, according to the report.
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The temporary program is set to run until the end of 2027.
This is the first time GLP-1s (glucagon-like peptide-1 receptor agonists) will be covered by insurance when used solely for weight loss.
Prior to this new Medicare pilot, seniors who wanted to access GLP-1s for obesity alone paid about $1,350-$1,650 per month for Novo Nordisk’s Wegovy (semaglutide) and about $1,086 monthly for Lilly’s Zepbound (tirzepatide). However, both manufacturers offered some cash-pay options that significantly reduced those prices for eligible patients.
There are some parameters surrounding the coverage — older adults must have had a body mass index (BMI) of 35 or higher when they started GLP-1 therapy, or a BMI of 27 or higher alongside another health condition, such as a past heart attack or stroke or prediabetes.
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Those who already have insurance coverage for other diseases, such as diabetes and sleep apnea, are not eligible for the program.
There are more than 70 million Americans currently enrolled in Medicare, 10 million of whom are overweight or obese, according to Juliette Cubanski, vice president and director of the program on Medicare policy at the healthcare research nonprofit KFF.
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"For many older Americans living with obesity, this is a moment they and their families have been waiting for," Jamey Millar, Novo Nordisk’s executive vice president of U.S. operations, said in a press release.
"The Medicare GLP-1 Bridge program offers a new, affordable path to an FDA-approved treatment that was previously not covered."
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Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, said he hopes the program can help his agency collect data to potentially work toward longer-term coverage, while providing immediate relief to cash-strapped older Americans, AP reported.
"The sheer cost of these medications is a huge barrier to access," he said in a call with reporters. "That ends today."
Oz told reporters that CMS plans to "carefully track participation and outcomes" to see whether an extension of the Bridge program or another solution is the best way to move forward. He told AP a federal law permanently allowing the coverage is "not essential right now" but something "for Congress to debate amongst themselves."
"We can’t decide what’s going to happen long term with Bridge until we see some of the data," he said, adding that there are ongoing talks with drug companies to lower costs.
One potential concern is that older patients tend to have more adverse effects to medication in general , according to Dr. Micah Eimer, a clinical assistant professor of cardiology at the Northwestern University Feinberg School of Medicine.
"Specifically, in our research, older patients on blood pressure medications were more likely to experience hypotensive side effects, such as fainting and dizziness, after starting a GLP-1," he said in a statement.
The Associated Press contributed to this report.