Key Points
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Medicare now covers select GLP-1s for weight loss for qualifying beneficiaries.
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You must have a Medicare plan that covers prescription drugs to be eligible.
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This GLP-1 Bridge program only lasts through Dec. 31, 2027.
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Medicare beneficiaries can now get GLP-1s for weight loss for $50 per month
Medicare beneficiaries have long had their GLP-1s covered for conditions like type 2 diabetes, but the program only began covering the drugs for weight loss on July 1. This is part of a new Medicare GLP-1 Bridge program that runs through Dec. 31, 2027.
Those who qualify will have a $50 copay on the following GLP-1s only:
- Foundayo (tablet)
- Wegovy (injection or tablet)
- Zepbound (KwikPen only)
But not every Medicare beneficiary will qualify for this offer. You have to meet the following criteria:
- You must have a Medicare Part D plan or a Medicare health plan that includes drug coverage.
- You’re not currently eligible to receive GLP-1s through your existing Medicare drug plan.
- You don’t have type 2 diabetes, moderate to severe sleep apnea, or fatty liver disease (your Medicare drug plan may cover GLP-1s for these conditions).
- You’re at least 18 years of age and meet one of the following criteria:
- You have a body mass index (BMI) of 35 or higher.
- Your BMI is 30 or higher, and you have certain types of heart failure, high blood pressure that’s hard to control, or chronic kidney disease (stage 3a or above).
- Your BMI is 27 or higher, and you have prediabetes, or you’ve had a heart attack, stroke, or blocked arteries in your legs or arms.
Your doctor can help you determine your BMI if you’re not sure. You’ll need to get a prescription from them, too.
What if you don’t qualify for the $50 copay?
If Medicare’s GLP-1 Bridge program isn’t right for you, you can check any supplementary health insurance policies you have to see if these cover GLP-1s for weight loss. It doesn’t hurt to reach out to the drug providers, too, to see if they have discounts for seniors or low-income families. You may also be able to find coupons online.
It’s not clear what will happen to Medicare’s GLP-1 coverage after the GLP-1 Bridge program ends. But it’s possible that your Medicare plan will cover these drugs in the future, even if it doesn’t today.
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