Medicare to launch weight loss drug option in July with $50 copay
6 hours ago
- #Weight Loss Drugs
- #Healthcare Policy
- #Medicare
- Starting in July 2026, Medicare will launch a short-term pilot program called the Medicare GLP-1 Bridge, offering coverage for weight loss drugs like Wegovy and Zepbound at a flat $50 monthly copay.
- Eligibility requires Medicare Part D enrollment and a BMI of 27+ with a health condition (e.g., heart disease) or a BMI of 35+ automatically qualifying; about 40% of U.S. adults are obese (BMI 30+).
- The program runs from July 1, 2026, to Dec. 31, 2027, and requires prior authorization via a centralized system managed by Humana, with prescriptions submitted by doctors.
- Cost savings are significant compared to current cash prices ($149-$699/month), but the $50 copay doesn't count toward Part D deductibles or the $2,100 annual out-of-pocket cap, and low-income subsidies (Extra Help) don't apply.
- After 2027, the future is uncertain; the Bridge program was extended due to lack of insurer participation in a voluntary long-term plan, potentially costing Medicare billions annually.