The Centers for Medicare & Medicaid Services has established a temporary demonstration program that will let some Medicare beneficiaries obtain certain GLP-1 weight-loss medications for a flat $50 monthly copayment through Dec. 31, 2027, the agency said.
Who can enroll
To participate, an individual must be enrolled in a qualifying Medicare Part D prescription drug plan. The program excludes some special Medicare coverage arrangements and does not apply to people who already receive a covered GLP-1 medication through their existing Part D benefits.
- Part D enrollment required: beneficiaries must have a qualifying Medicare Part D plan.
- Not for current GLP-1 users: those already covered for GLP-1s under their drug plan are ineligible and should continue using their plan benefits.
- Health criteria: participants generally must meet weight and health thresholds, such as a body mass index of at least 35 or a lower BMI together with specified cardiometabolic conditions.
Covered drugs and cost
According to the National Council on Aging, the demonstration covers the following products under the program: Foundayo, Wegovy and Zepbound KwikPen. Eligible beneficiaries pay a uniform $50 monthly copayment while the demonstration is in effect, regardless of income.
| Covered product | Copayment | Program end date |
|---|---|---|
| Foundayo | $50 per month | Dec. 31, 2027 |
| Wegovy | $50 per month | Dec. 31, 2027 |
| Zepbound KwikPen | $50 per month | Dec. 31, 2027 |
Medical exclusions and conditions
CMS said certain medical conditions may affect eligibility because some GLP-1 drugs are already covered by standard Part D benefits for particular diagnoses. For example, people with type 2 diabetes, moderate to severe sleep apnea or fatty liver disease may be ineligible for the Bridge program because Medicare Part D can cover GLP-1s for those conditions.
The demonstration’s health-related eligibility typically requires a body mass index threshold or a lower BMI combined with other conditions such as uncontrolled high blood pressure, chronic kidney disease, prediabetes, a prior heart attack, stroke or peripheral artery disease.
Administration and timeframe
CMS described the program as temporary and limited to the specified covered products and timeframe, with the demonstration running through the end of 2027. Eligible beneficiaries who meet the enrollment and clinical criteria may obtain the listed GLP-1 treatments for the flat monthly copay while the program is active.
People who already receive GLP-1 medications through their Medicare drug plan should continue to obtain them under their current coverage arrangements and are not eligible to enroll in the Bridge demonstration.
