GLP-1 coverage has expanded, and millions of older adults are now eligible for the weight-loss drugs under Medicare for just $50 a month. Experts say the coverage can improve long-term health and potentially save healthcare dollars in retirement.
Starting July 1, the GLP-1 Bridge program expands access to certain weight-loss medications for eligible Medicare beneficiaries. The temporary program will run through the end of 2027.
The bridge program comes as federal regulators explore broader coverage policies. As GLP-1 medications have surged in popularity, American's use of the injectables has quadrupled since 2024 — 11% of the population are using them for weight-loss purposes in 2026, up from 3% two years ago,
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Though they're intended to treat Type 2 diabetes, GLP-1s have shown to lower the risk of heart attacks, strokes in patients with obesity and heart disease, lower blood pressure and even ease addiction habits.
But for years, the drugs have been barred from some patients due to sky-high costs. Medicare coverage can change that.
Who qualifies for GLP-1s under Medicare?
Not every Medicare beneficiary will be eligible for the program, according to the
About 4 million are eligible, according to KFF.
The bridge program allows Medicare coverage of GLP-1s for obesity for a $50 monthly copayment, but it will not count toward the Part D deductible or out-of-pocket spending cap, according to KFF. But it still offers a heavy discount.
Those who qualify need to meet the clinical criteria, said Dr. Dennis Weaver, chief clinical officer at Pearl Health. Physicians have to sign off on patients needing the medication before Medicare will approve.
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The program covers three GLP-1s — Wegovy, Zepbound, and Foundayo — that have been approved by the Federal Drug Administration for weight management in adults with obesity. It treats patients with a BMI of 30 or higher, or BMI of 27 or more plus a weight-related comorbid condition, according to KFF.
The program also is limited to beneficiaries who have not filled a prescription under their Part D plan for a GLP-1 in 2026.
Long term health and retirement
The biggest advantage to Medicare's coverage is that expanded access can help long-term health outcomes in adults.
When managing obesity, which is a chronic condition, using a GLP-1, downstream effects that lead to improved health potentially save thousands of dollars of health care expenses in the long run, Weaver said.
A recent estimate found a retiree can expect to spend
Long-term care is getting more expensive as well, primarily due to inflation. The cost of services and support increased nearly 50% from 2019 to 2024, according to AARP.
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"You're going to see a corresponding drop in heart attacks, heart failure, strokes, permanent disability — all of which the government would end up paying for over a longer actuarial time frame," said Dr. Warris Bokhari, CEO and co-founder of Claimable, a company that supports GLP-1 coverage denials. "Medicare paying for this medication effectively becomes like the new preventative medicine for the older cohort of a population where you're preventing outcomes."
With brand-name GLP-1s costing $700-800 per month in the U.S. even when accounting for long-term health gains, researchers found that GLP-1 drugs
Long-term Medicare coverage could change that.
The most crucial aspect Medicare beneficiaries need to plan around with the program is that GLP-1s are a long-term treatment, Weaver said. Its use needs to be factored around Part D coverage costs.
"You need to look at what drugs you're going to be on, how you're going to manage those drugs, and how you're going to do this in your Part D cost," Weaver said. "If you're going to use these GLP-1s probably for a long time, and every year when your medicines change, you have to think through 'how am I either going to pay for these or how will my Medicare in Part D get me to help cover these?'"
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Looking to the future
One aspect of the bridge program that remains to be seen is the rejection rate when the temporary program ends, Bokhari said.
"It's going to be incumbent upon the manufacturers to work with (Centers for Medicare & Medicaid Services) to make sure access continues to occur through this program for the older population," Bokhari said.
If prior authorization is implemented into Medicare, like through the
A beneficial tradeoff is there is now a lower appeal burden on the older population, Bokhari said. A $50 copay is a reasonable trade if older adults no longer have to fight their own appeals to get covered — a difficult process.
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This 18-month bridge program is a trial run to see if the drugs should be covered long term, Weaver said.
"The working belief is that it'll be cheaper in the long run to cover the drugs, have people lose weight and not live with the chronic disease," Weaver said. "It will be the best interest of both the patient and society."
