A new initiative from the Centers for Medicare and Medicaid Services is changing how some beneficiaries access weight-loss medications. The Medicare GLP-1 Bridge is an 18-month demonstration project launched on July 1 to evaluate whether broader access to specific drugs can improve health outcomes and lower long-term medical costs for seniors and others on Medicare.
Under this program, eligible participants can access medications such as Foundayo, Wegovy, and Zepbound for a flat rate of 50 dollars per month. This project targets individuals who currently pay full price for these medications because their existing insurance plans do not cover weight-loss drugs and they lack qualifying conditions like diabetes or severe sleep apnea. KFF estimates that nearly 3.8 million Medicare beneficiaries nationwide may qualify for this new path, with potentially 50,000 in Oregon alone.
Eligibility criteria are specific. To participate, individuals must be enrolled in a Medicare drug insurance plan. Furthermore, they cannot have filled an insurance-covered GLP-1 prescription this year, nor can they have a current plan that provides coverage for these weight-loss drugs. A body mass index of 35 or higher acts as one of the primary health qualifiers for the program.
Physicians play a central role in this process. Doctors are required to submit an enrollment form to CMS, which aims to provide a response within 72 hours. It is important to note that costs associated with this demonstration project remain separate from standard Medicare drug benefits. As a result, payments made for these medications do not count toward the annual out-of-pocket spending cap of 2,100 dollars. Even those who receive assistance for other pharmacy costs will still be responsible for the full 50 dollar monthly fee under this bridge program. The project is scheduled to run through the end of 2027.