Medicare will begin covering obesity drugs for eligible beneficiaries starting Wednesday through a new Bridge demonstration program, offering GLP-1 medications for a $50 monthly copay. The program sidesteps federal law that currently bans Medicare coverage solely for obesity, temporarily expanding access to treatments from Novo Nordisk and Eli Lilly for millions of older Americans ages 65 and above who were previously unable to afford these medications. Several million of Medicare's 69 million total beneficiaries are expected to access the drugs through Bridge, according to Chris Klomp, director of Medicare and deputy administrator of the Centers for Medicare and Medicaid Services. The coverage represents a watershed expansion for a patient population where an estimated 15 million to 20 million older adults qualify for weight loss drugs, though the program is scheduled to expire at the end of 2027 unless extended by the Trump administration.
Medicare Bridge Program Offers $50 Monthly Copay for GLP-1 Medications
The $50 monthly copay applies to all doses and does not count toward a patient's Part D deductible or the $2,100 annual out-of-pocket cap on prescription drug costs, according to Rachel Schmidt, a research professor at Georgetown University's McCourt School of Public Policy. This represents significant savings compared to out-of-pocket costs for patients without insurance coverage. Novo Nordisk's Wegovy injections range from $199 for a lower dose to $399 for the highest dosage, while Eli Lilly's Zepbound costs from $299 to $699 per month depending on dose. The Wegovy pill costs $299 at the highest dosage, while Lilly's Foundayo tops out at $349.
The Bridge program operates differently from traditional Medicare drug coverage. It is funded by taxpayer dollars and beneficiary copays rather than private insurers running Part D plans. Covered medications include Novo's Wegovy injection and tablet form, as well as Lilly's Foundayo pill and Zepbound in the KwikPen formulation. Ilya Yuffa, president of Lilly USA and global customer capabilities, said the company chose to include only the KwikPen form of Zepbound because it contains a month's worth of doses in one pen.
A quarter of Medicare beneficiaries had an income below $24,600 in 2024, according to KFF, a health policy research organization. "This is going to improve access to so many Americans who need these medications, and either are going without or using their hard-earned money in retirement to pay for them," said Dr. Holly Lofton, director of the Medical Weight Management Program at NYU Langone.
Eligibility Criteria Include BMI 35 or Higher and Related Health Conditions
Eligible patients include those with a body mass index of 35 or higher, as well as some people with lower BMIs who have at least one related condition, such as prediabetes, a previous heart attack or stroke, or blocked arteries in their arms or legs. A healthcare provider must determine whether a person meets clinical requirements for coverage based on their body weight and health status. Part D plans do not determine eligibility or approve coverage under this program.
To obtain coverage, a provider must first send a prescription to the patient's pharmacy, which triggers a prior authorization request for the Bridge program. The provider must complete this request to certify that the individual is eligible, then submit it directly to Humana, which CMS contracted to process approvals for Bridge. Once a request receives final approval, patients pay the flat $50 copayment at the pharmacy when picking up the prescription.
People who already have coverage of a GLP-1 from their Part D plan for uses already covered by Medicare, such as Type 2 diabetes, cardiovascular disease risk reduction or sleep apnea, do not qualify for the Bridge program. Those patients will continue to access the drug through traditional coverage.
NYU Langone's Lofton called the eligibility criteria "appropriate" and broader than what she has seen with commercial insurance. The inclusion of people with prediabetes represents an effort to prevent diabetes in the Medicare population, "which will ultimately reduce healthcare costs nationally," she added.
Providers Raise Concerns About Prior Authorization Process and Demand Surge
The launch of Bridge could create new pressures for physicians, pharmacies and the prior authorization process, some experts said. Dr. Carolynn Francavilla Brown, a physician and vice president of the Obesity Medicine Association, said the healthcare system is already stretched thin, with many Medicare beneficiaries facing long waits for appointments with doctors. After Bridge begins, doctors and specialists will likely deal with an influx of patients seeking appointments, while pharmacists grapple with an increase in prescriptions for the drugs.
"I do think we're all going to have to be a little bit patient, because there is probably going to be a bit of a strain on clinics and pharmacies for the next couple of months as people very excitedly start these medications," Francavilla Brown said. Patients should not expect to pick up a medication immediately on July 1, she added.
Providers must submit paperwork for every patient seeking coverage, and the volume of requests could be substantial since so many people are eligible. Dr. Shauna Levy, medical director of the Tulane Bariatric and Weight Loss Center, said the process could be "potentially cumbersome," but her clinic has already begun preparing by adding providers and identifying patients who may qualify for the program.
CMS expects prior authorization requests to be processed within 72 hours of being received and is encouraging providers to use electronic submissions to speed up reviews, an official told reporters on Thursday. Francavilla Brown noted that one potential advantage of Bridge is that it is administered through a single program rather than multiple insurance plans, which could make authorization more streamlined and consistent.
In a statement to CNBC, Humana said it has 15 years of experience administering a temporary Medicare drug coverage program for low-income beneficiaries and will play a similar operational role in Bridge. CMS remains responsible for program costs, pharmacy payments and beneficiary communications, among other efforts.
Novo Nordisk and Eli Lilly Position for New Medicare Patient Population
The new coverage could unlock millions of potential patients for Novo and Lilly, intensifying their competition in the obesity market. Lilly currently leads with roughly 60% market share, compared with Novo's 39% as of the first quarter. Neither company has disclosed revenue projections for Bridge. Lilly's Yuffa said uptake will depend on factors including patient and physician awareness and how smoothly the health-care system handles demand, which will take time to build.
Leerink Partners analyst David Risinger said he expects volume growth of the companies' obesity drug prescriptions to start picking up in July, with "rapid adoption" over the second half of the year. He said the program could bring in more than a billion dollars in annual revenue for each company, but expects no major changes in their market share.
Novo and Lilly's oral obesity drugs may be particularly attractive to seniors, Risinger said. The Wegovy pill surpassed 3 million prescriptions in its first five months on the market, while Lilly launched Foundayo in April. Novo's market research found that 75% of seniors prefer a daily pill over a weekly injection, according to Jamey Millar, the company's executive vice president of U.S. operations.
Millar described Bridge as a significant opportunity for both companies to compete for a new patient population. He said Novo is confident it can sustain the strong uptake of the Wegovy pill as the program launches, touting that the pill has slightly higher efficacy and fewer drug-to-drug interactions compared to Lilly's. "From my perspective, both companies are treating this very intentionally and seriously as an opportunity for access," Millar said.
If the program proves that coverage results in cost savings for CMS and improved health outcomes, that could put pressure on more private insurers and employers to cover GLP-1s for obesity on commercial plans, he added.
Program Expires End of 2027 Without Confirmed Extension Plan
There is uncertainty about what happens after Bridge expires at the end of 2027, raising questions about whether beneficiaries who start treatment will be able to stay on it long term. "That's very concerning, because these are treatments that are meant to be lifelong, just like treatments for hypertension, for diabetes and for any other condition you have," said Caroline Apovian, co-director of the Center for Weight Management and Wellness at Brigham and Women's Hospital.
Evidence shows patients often regain weight after discontinuing GLP-1 treatment. One 2022 study found that people who stopped taking Wegovy regained roughly two-thirds of their prior weight loss within a year.
CMS originally planned for Bridge to serve as a six-month transition to a longer-term program called Balance, which would shift the responsibility for covering the drugs to private insurers running Part D plans. However, insurers including CVS and UnitedHealthcare declined to participate voluntarily, citing concerns about the program's structure and costs. CMS subsequently extended Bridge through 2027 and plans to use data from the demonstration to encourage participation in Balance.
"We're going to carefully track participation and outcomes" in Bridge, a CMS official told reporters on Thursday. "We want to understand how extended access affects program operations, and we're going to learn a lot more, but also really use its wisdom for smarter policy in the future."
The challenge is that Balance remains voluntary, leaving no guarantee that coverage will continue for all patients, said Kenneth Thorpe, a health policy professor at Emory University. A more permanent solution would be passage of a bill called the Treat and Reduce Obesity Act, which would lift Medicare's longstanding ban on coverage of obesity drugs. Despite bipartisan support, concerns about cost have slowed the legislation. The Congressional Budget Office estimated in 2024 that the bill would increase federal spending by $35 billion over nine years.
Supporters argue that estimate may overstate the net cost because it does not fully capture potential savings from preventing obesity-related conditions. One 2025 study projected more than $18 billion in health-care savings over a decade. Thorpe added that the price of GLP-1s has decreased significantly since the CBO study, and that more drugmakers are developing their own treatments, which could drive prices even lower.
FAQ
How much will Medicare beneficiaries pay for obesity drugs under the Bridge program?
Eligible Medicare beneficiaries will pay a flat $50 monthly copay for GLP-1 obesity medications under the Bridge demonstration program starting Wednesday. This copay applies to all doses and does not count toward a patient's Part D deductible or the $2,100 annual out-of-pocket cap on prescription drug costs, according to Rachel Schmidt, a research professor at Georgetown University's McCourt School of Public Policy. This represents significant savings compared to out-of-pocket prices, which range from $199 to $699 per month depending on the medication and dose.
Who qualifies for Medicare obesity drug coverage under the Bridge program?
Eligible patients include Medicare beneficiaries with Part D coverage who have a body mass index of 35 or higher, as well as some people with lower BMIs who have at least one related condition such as prediabetes, a previous heart attack or stroke, or blocked arteries in their arms or legs. A healthcare provider must determine whether a person meets clinical requirements for coverage and submit a prior authorization request to Humana, which CMS contracted to process approvals. People who already have coverage of a GLP-1 from their Part D plan for conditions like Type 2 diabetes or cardiovascular disease do not qualify for the Bridge program.
How long will the Medicare Bridge program for obesity drugs last?
The Bridge demonstration program is scheduled to expire at the end of 2027 unless extended by the Trump administration. CMS originally planned for Bridge to serve as a six-month transition to a longer-term program called Balance, but insurers including CVS and UnitedHealthcare declined to participate voluntarily. A CMS official told reporters on Thursday that the agency will track participation and outcomes to inform future policy. A permanent solution would require passage of the Treat and Reduce Obesity Act to lift Medicare's longstanding ban on coverage of obesity drugs, though concerns about cost have slowed the legislation despite bipartisan support.
