Millions of older Americans could have access to anti-obesity drugs for the first time at a low price of $50 a month starting in July under a Medicare pilot program.
While Medicare Part D already covers some GLP-1 drugs for conditions such as diabetes, cardiovascular disease and sleep apnea, the government program for people 65 and older had banned coverage only for obesity. Now, more people with Medicare will be eligible, including those who are more overweight and those with obesity and conditions such as prediabetes or uncontrolled hypertension.
The monthly price of $50, which will cover any number of doses, is much lower than what Medicare patients currently pay out of pocket for GLP-1s.
About 40 percent of the 70 million people enrolled in Medicare meet the clinical definition of obesity, data from the Centers for Disease Control and Prevention show. The Congressional Budget Office estimates that 29 million Medicare beneficiaries would then qualify for GLP-1 drug coverage, although 16 million already have access for conditions such as diabetes or cardiovascular disease.
But many seniors may not be able to pay an extra $600 a year for another prescription since they are already struggling with rising health care costs. KFF, a health research organization, reported that one in four Medicare beneficiaries had an income less than $24,600 in 2024, and half lived on incomes less than $43,200.
Another concern is whether the program would be extended beyond 2027. Although the pilot could continue, adding the benefit permanently would require a change in federal law and an agreement between health insurance companies to offer the drugs in Part D prescription drug plans.
The financial burden on Medicare is another consideration if such coverage were extended. The CBO estimated that adding weight-loss drugs would cost Medicare $35 billion between 2026 and 2034. A spokesperson for the Centers for Medicare and Medicaid said the agency had not released cost estimates for either the pilot, called the Medicare GLP-1 Bridge program, or the permanent model.
Here’s what Medicare beneficiaries seeking coverage should know about the pilot program.
Who can participate?
Those eligible include not only enrollees age 65 or older, but also Medicare beneficiaries with disabilities.
The Bridge program is temporary and is open primarily to people who are already enrolled in a Part D prescription drug plan or private Medicare Advantage plans that include drug coverage. But your Part D provider will not offer coverage.
“Your Part D plan will have nothing to do with making decisions about whether or not you can access a GLP-1 under the Bridge model,” said Juliette Cubanski, deputy director of KFF’s Medicare policy program.
Instead, a healthcare provider must determine whether you meet the Bridge Program’s clinical requirements, which are based on body weight and health status. Patients with a body mass index of 35 or higher will qualify; Those with a lower BMI may also qualify if they have been diagnosed with other related conditions.
Providers will need to submit a prior authorization request and prescription to Humana, which will process the requests.
If your application is approved, you will be able to fill your prescription at any pharmacy. The list of GLP-1s that can be prescribed for obesity includes Eli Lilly’s Foundayo and Novo Nordisk’s Wegovy in injectable and tablet form; and Lilly’s Zepbound KwikPen.
If you are taking a GLP-1 drug for a different condition, such as diabetes, it will still be covered by your Part D plan.
How much will this cost?
The $50 per month copay is separate from any premium or deductible you pay for Part D. Because Bridge purchases are processed outside of Part D, the monthly cost does not count toward Part D deductibles or out-of-pocket limits.
Seniors with very low incomes generally qualify for assistance with Part D costs through a federal program called Extra Help, which subsidizes premiums, deductibles and cost sharing. That assistance will not be available because the program runs outside of Part D.
Those who have both Medicare and Medicaid coverage and are not required to make copays, or minimum copayments at most, would be eligible. But the $50 a month price would apply to them too.
“It may be difficult for low- and modest-income seniors to participate and take advantage of the new coverage,” said Ramsey Alwin, executive director of the National Council on Aging.
State Medicaid programs already have the option to cover GLP-1 medications for obesity treatment, but only a dozen states do so, according to KFF.
Why is this outside of Part D?
Federal law prohibits Medicare from covering prescription drugs specifically for weight loss; Making GLP-1 coverage permanent would require an act of Congress. In the meantime, CMS has the legal authority to run time-limited “demonstration projects” to test new payment or coverage approaches like this one.
The federal government had intended to move coverage of weight-loss drugs from its pilot plan to Part D in 2027. But health insurance companies resisted because of the potentially high costs of covering enrollees and a lack of data to determine the number of patients that would guide their pricing plans next year, said Kylie Stengel, director of Avalere Health, a research and consulting firm.
“There really is no historical data on the use of GLP-1 for obesity in Medicare, and insurance plans really need that data to assess that risk so they can accurately set plan prices,” he said.
Will I be able to continue receiving the medications after the pilot ends?
It’s an important question, because research shows that most people need to keep taking medications to maintain weight loss or other health benefits. There is no clarity on next steps, said KFF’s Dr. Cubanski. Much will depend on whether CMS can persuade more insurance plans to participate.
“The real big question is what will happen at the end of 2027 if CMS is not able to maintain this model in Part D,” he said.
Even if Part D permanently covers GLP-1 for weight loss, some people will not be able to afford the drugs. Cost sharing is expected to increase above the pilot’s monthly fee of $50.
A recent study from the University of Pennsylvania found that monthly cost sharing for GLP-1 drugs already covered by Part D reached an estimated $167 per month last year.
“I would expect similar costs for weight-loss drugs, and perhaps higher,” said Matthew Klebanoff, an assistant professor of medicine at the University of Pennsylvania and an author of the study.
A survey conducted by KFF found that more than half of GLP-1 users said these medications were difficult to afford, and one in four said they were “very difficult” to afford.
The price of these drugs makes forecasts uncertain. The drugmakers agreed to supply weight-loss drugs to Medicare enrollees at a net price of $245 a month, a steep discount compared to prices in commercial markets.
It’s also unclear how much Medicare could save over time, considering the potential for reductions in obesity-related health conditions, including metabolic, cardiovascular and respiratory diseases. The CBO estimate included $3 billion in savings over that period, but that figure may be conservative.
One group of researchers projected savings of $18 billion over a 10-year period. “We found large subsequent reductions in rates of diabetes and cardiovascular disease, in particular,” said Elbert Huang, a professor of medicine at the University of Chicago and co-author of the study.
The affordability issue, along with uncertainty about whether the pilot will lead to permanent coverage under Part D, worried some experts. Millions of older people could start GLP-1 treatment for obesity, but then suddenly be stopped.
“There is a lot of concern about people having yo-yo experiences with GLP-1 medications,” Dr. Huang said. “When people stop treatment, not only do they regain the weight they lost, but the weight they regain is predominantly fat.”
“We are about to conduct a gigantic national experiment with older adults in the United States,” he added.
