The federal government is capping the monthly cost of certain GLP-1 weight loss medications at $50 for eligible Medicare recipients. The program covers Wegovy, Foundayo, and Zepbound KwikPens and runs from July 1 through December 31, 2027.
According to Healthline, the Department of Health and Human Services announced the Medicare GLP-1 Bridge pilot program earlier this month. An estimated 14 million people in the United States could qualify.
To be eligible, a person must be at least 18 years old, enrolled in Medicare Part D, and using the medication specifically for weight loss or weight management. Qualifying participants must also meet at least one clinical threshold. Those include a body mass index of 35 or higher, a BMI of 30 or higher combined with conditions such as heart failure, uncontrolled hypertension, or chronic kidney disease, or a BMI of 27 or higher alongside other health risks such as prediabetes or peripheral artery disease.
Mehmet Oz, the administrator of the Centers for Medicare and Medicaid Services, addressed the cost barrier directly. "These treatments are a major medical advancement, but too many seniors are currently unable to access them due to high cost," he said in a statement. "The Medicare GLP-1 Bridge changes that by making these medications more affordable and accessible, while advancing our broader goal of helping Americans live healthier lives."
Before the pilot program, Medicare did not cover GLP-1 medications prescribed for weight loss. The agency does currently cover these drugs when prescribed for type 2 diabetes or obstructive sleep apnea, but recipients who enroll in the bridge program will not be eligible for that existing coverage.
The cost of GLP-1 medications on the open market ranges from $149 per month through certain self-pay options to as much as $1,349 per month. The $50 copay under the pilot program will not count toward the annual Part D deductible, which can reach $615 in 2026. The payments also will not count toward the yearly Part D out-of-pocket spending cap of $2,100.
Not all Zepbound formulations are covered. Single-use pens and vials will be excluded from the program. Only the KwikPen version qualifies.
The bridge program follows a separate initiative launched last year called Trump Rx, which was also designed to lower costs for GLP-1 medications and other higher-priced drugs.
The pilot program is set to run for 18 months, ending December 31, 2027.
