Starting in July, some Medicare beneficiaries will be able to access GLP-1 medications by paying one flat fee per month under a temporary program running through the end of 2027. The Medicare GLP-1 Bridge, described by the Centers for Medicare and Medicaid Services (CMS) as a "time-limited demonstration," will officially run from July 1, 2026, to Dec. 31, 2027.
The 18-month program was announced in December and allows eligible Medicare Part D enrollees to access GLP-1 medications indicated for weight management at a $50 monthly copay. Federal law currently prohibits Medicare from covering weight loss medications, making the Bridge program an alternative pathway for beneficiaries seeking obesity treatment through their Part D coverage.
What the Left Is Saying
Obesity care advocates have largely welcomed the program as a significant step forward. The Obesity Care Advocacy Network (OCAN) praised the initiative, with OCAN Coordinator Cristy Gallagher calling it a "historic milestone in the fight against the obesity epidemic."
Catherine Varney, an obesity medicine physician and trustee at the Obesity Medicine Association, described during an OCAN webinar who would most benefit from the program. "Those at greatest risk of obesity and obesity-related diseases," said Varney. "We know that obesity is not a benign disease ... it's associated to over 200 chronic conditions and 13 different types of cancers."
The program requires no additional paperwork for Medicare enrollees beyond getting a prescription from their doctor, according to CMS. Beneficiaries must be at least 18 years old with a body mass index (BMI) of 27 or higher and diagnosed with at least one qualifying condition such as prediabetes, previous myocardial infarction, previous stroke, or symptomatic peripheral artery disease.
What the Right Is Saying
Some regulatory observers have raised concerns about how the program will be administered. Christopher J. Frisina, healthcare regulatory counsel at the law firm Alston & Bird, noted that many telehealth visits are considered sufficient to obtain a prescription eligible for the Bridge program.
"I think maybe that this GLP-1 Bridge program might inspire new telehealth providers or existing telehealth providers that to this point haven't taken Medicare reimbursement to move into this space," Frisina told The Hill. "And it's a risky place, because Medicare requires more diligence in business practices than a lot of businesses do."
Frisina acknowledged CMS appears to have done its due diligence but cautioned about fraud potential. "It requires the provider to fill up this really detailed prior authorization form to send that in before approval can happen," he said. "So you have a check and balance that requires the coordination between two different entities, the provider and the pharmacy, to actually get the fraud. It's not going to be as straightforward as some of the fraud schemes that we often see, but I don't think it's outside of the realm of possibility."
What the Numbers Show
The Bridge program will cover Wegovy, Zepbound and Foundayo for eligible beneficiaries. To participate, patients must have a medical provider submit a prior authorization request attesting they do not have Type 2 diabetes, moderate to severe obstructive sleep apnea, or MASH fatty liver disease.
Eligibility requirements vary based on BMI thresholds. Those with a BMI of 35 or greater do not require an additional diagnosis to participate in the Bridge program. The $50 monthly copay will not count toward a patient's deductible or maximum out-of-pocket costs.
"CMS has not publicly released cost estimates or enrollment projections for the Medicare GLP-1 Bridge demonstration model," an agency spokesperson told The Hill.
The Hill also reached out to the Department of Health and Human Services for information on the program's cost. Those inquiries had not been answered at time of publication.
The Bottom Line
The program represents a significant shift in how Medicare beneficiaries can access obesity treatments, operating outside traditional Part D coverage rules due to federal restrictions on weight loss medication coverage.
When asked what plans exist for after Dec. 31, 2027, Aurelia Chaudhury, co-lead of CMS's Cell and Gene Therapy Access Model, said during an OCAN webinar: "We understand that there's a lot of interest from patients in understanding what's going to happen after December 31st of 2027. We are looking forward to sharing more information as soon as we can on Medicaid."
Beneficiaries should note claims will not be processed before July 1, and those interested in the program should consult with their healthcare providers about eligibility based on individual medical circumstances.