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 July 1, allows enrollees to qualify for a weight-loss prescription drug based on height, weight and other criteria — and only has to pay $50 monthly.
The bridge program is an important change because Medicare, the federal health program primarily for adults age 65 and older, is prohibited from covering weight-loss drugs, including GLP-1.
Who is eligible?
According to the CMS website, to qualify for the Medicare GLP-1 Bridge Program, a beneficiary must:
- Get prescription drug coverage under Medicare, known as Medicare Part D
- be at least 18 years old
- Keep a certain BMI, or body mass index, height and weight measurements.
- Request medication for weight loss along 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 others may also be considered.
People must also get a prescription from a doctor or other licensed prescriber, and they are subject to prior authorization.
“Medicare GLP-1 Bridge was designed to expand access to GLP-1 for beneficiaries who seek the medication solely to reduce excess body weight or maintain weight loss,” the CMS website notes, adding that other indications, such as type 2 diabetes and sleep apnea, are eligible for coverage outside this program.
How long will the program run?
The bridge program will run until the end of 2027. It’s unclear what will happen after this time, but for now, the program can help adults access popular drugs, which can exceed $1,000 in list price and are not always covered by insurance.
Although drug makers have cut prices for customers who pay cash, more than half of adults on GLP-1 say it has become difficult to afford drugs, according to the health policy nonprofit KFF.
Contributing: Ken Altaker, USA TODAY.