Starting July 1st, the U.S. Medicare program will officially launch a "GLP-1 Bridge Program," marking the first time it will provide coverage for weight-loss medications to eligible patients with obesity. Under this initiative, beneficiaries enrolled in a Medicare Part D prescription drug plan can access Novo Nordisk's Wegovy, as well as Eli Lilly's Zepbound and Foundayo, for a monthly co-payment of $50.

This temporary program will operate until December 31, 2027. It is designed to bridge the gap created by federal law, which currently prohibits Medicare from covering weight-loss drugs independently, until a more permanent demonstration project is fully implemented. To qualify, patients must meet specific clinical criteria, including having a body mass index (BMI) of 35 or higher; a BMI of 30 or higher accompanied by conditions such as heart failure, uncontrolled hypertension, or chronic kidney disease; or a BMI of 27 or higher with pre-diabetes, a history of heart attack, or stroke.

The program will function separately from standard Medicare Part D benefits. A designated entity will manage prior authorizations and claims reviews. Pharmacies must submit prescriptions through a dedicated channel, not through the patient's existing Part D plan. It is important to note that the $50 monthly co-payment will not count toward the patient's Part D deductible or annual out-of-pocket maximum.

Estimates suggest that between 15 million and 20 million Medicare beneficiaries could meet the criteria for these medications. Both Novo Nordisk and Eli Lilly have welcomed the program, viewing it as a significant step in recognizing obesity as a chronic condition requiring treatment. However, the program is set to expire at the end of 2027, leaving uncertainty about long-term coverage for patients. A change in law or a further extension of the program will be necessary to continue access beyond that date.