The Centers for Medicare & Medicaid Services has introduced a temporary Medicare GLP-1 Bridge program, allowing eligible beneficiaries to access certain weight-loss medications at $50 per month. This initiative seeks to reduce affordability barriers, as CMS Administrator Dr. Mehmet Oz explained during an internal meeting. “Fifty dollars a month is a predictable, affordable price,” he stated, highlighting how the program expands access without altering current coverage arrangements.
The bridge includes coverage for Foundayo, Wegovy injections and tablets, and Zepbound KwikPen. However, Zepbound single-dose vials and pens are not included. It targets individuals without prior Medicare pathways for these medications, with no changes for existing users. The demonstration period runs from July 1, 2027, to December 31, 2027, outside standard Medicare Part D benefits. Part D sponsors avoid financial risk, and beneficiaries pay a $50 copay, separate from deductibles or low-income subsidies.
Related: Australia backs biotech with tax incentives
Manufacturers supply the drugs at $245 per monthly dose. To qualify, beneficiaries must have a BMI of 35 or higher, or 30 with heart failure, uncontrolled hypertension, or chronic kidney disease, or 27 with prediabetes or prior stroke. Prescriptions must align with weight reduction goals and incorporate lifestyle adjustments. Medications for Type 2 diabetes or sleep apnea remain covered under Part D, not the bridge.
Healthcare providers must submit prior authorization requests electronically or via fax, with CMS aiming for 72-hour processing times. Resubmissions are allowed for corrected information, though no formal appeals process exists. Humana will manage claims, and coupons cannot be applied to bridge-covered drugs. CMS expects no premium changes, as Part D plans avoid associated costs.
Related: How to choose the right packaging for your product?
The program will gather data on participation, adherence, and health outcomes to guide future decisions. Dr. Oz mentioned challenges in medication uptake, calling it a “psychology experiment” to assess real-world usage. Medicare currently limits GLP-1 drugs to non-obesity conditions like diabetes or cardiovascular risk reduction.
Initially, CMS proposed a two-step approach: the bridge and the BALANCE model, a Medicare Innovation Center initiative delayed until 2027. The bridge’s extension shows efforts to expand GLP-1 access in Medicare and Medicaid. Demand for these drugs has grown sharply, with prescriptions for overweight adults increasing 586.7% between 2019 and 2024, according to FAIR Health.
Related: What is a DNA gender test?
Cost concerns remain. A Health Affairs study estimated $3.1 billion in annual Part D spending if 5% of eligible beneficiaries used anti-obesity drugs. The Congressional Budget Office projected $35 billion in Medicare costs from 2026 to 2034, with limited savings offsetting expenses. CMS plans to share bridge data with Part D plans, aiming to refine coverage strategies as the program evolves.