FILE: GLP-1 weight loss injection pens (Photo by: Michael Siluk/UCG/Universal Images Group via Getty Images)
GLP-1 weight loss drugs will be a lot cheaper for many older Americans with the rollout of Medicare’s $50-a-month GLP-1 program.
The temporary program starts Wednesday. For many older adults, it’s the first opportunity to get GLP-1s, short for glucagon-like peptide-1 receptor agonists, covered by insurance when used strictly for weight loss.
Here’s what to know:
Who’s eligible for Medicare’s $50 GLP-1 drugs?
What we know:
The federal government is offering a selection of the brand name medications to certain Medicare and Medicare Advantage beneficiaries for $50 a month through a new trial called Medicare GLP-1 Bridge.
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To qualify, besides having Medicare drug coverage, you must have a body mass index of 35 or higher, or a BMI of 27 or higher alongside another health condition, such as a past heart attack or stroke, prediabetes or another from a list on the CMS website. BMI measurements are counted at the start of GLP-1 therapy — so even people who fall below the threshold now can qualify if they can show they had a high enough BMI when they began taking the drugs.
Medicare beneficiaries who have sleep apnea, diabetes or fatty liver disease can’t access the program, but their Medicare Part D insurance might cover their GLP-1s separately based on those diagnoses.
What they're saying:
"The sheer cost of these medications is a huge barrier to access," Dr. Mehmet Oz, the administrator of the Centers for Medicare & Medicaid Services, said in a call with reporters. "That ends today."
By the numbers:
Of the more than 70 million Americans enrolled in Medicare, at least 10 million are overweight or obese, according to the healthcare research nonprofit KFF.
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What we don't know:
It’s not clear how many of those will be eligible. Oz declined to speculate on the number with reporters.
How to sign up for Medicare’s $50 GLP-1 program
What you can do:
If you think you might qualify, the first step is to contact your health care provider, CMS says on its website. The provider must send a prescription for one of the covered GLP-1 drugs to a pharmacy and fill out a prior authorization form.
Which GLP-1s are covered?
The GLP-1s covered include Eli Lilly’s Foundayo tablets and Zepbound KwikPens and Novo Nordisk’s Wegovy injections and tablets. Those GLP-1s have been approved by the Food and Drug Administration for weight loss.
Does the cost go up with dosage?
For those in the program, the cost is $50 per month, regardless of dosage. But those payments won’t contribute to their insurance deductibles or out-of-pocket maximums. That’s because Medicare, rather than the Part D insurer, is subsidizing the prescription.
How long will the Medicare GLP-1 program last?
Timeline:
The program is scheduled to end after Dec. 31, 2027. And since Congress hasn’t authorized Medicare to cover weight loss drugs permanently, the federal government is limited in its options to keep the access flowing.
Congress could pass a law to allow the drugs to be covered. CMS also could move forward with a different, voluntary pilot program for covering the drugs called BALANCE, which the agency indefinitely delayed earlier this year when many Part D insurers were reluctant to sign up.
Oz said he hopes the program can help his agency collect data to potentially work toward longer-term coverage, while providing immediate relief to cash-strapped older Americans.
The Source: This report includes information from The Associated Press.