Medicare’s $50-a-Dose GLP-1 Benefit for Weight Loss Is Here

​Millions could qualify for $50 GLP-1 copays

Originally planned to run for six months through the end of 2026, the nationwide bridge program marks a significant coverage milestone for Medicare. Until now, the program wouldn’t cover any GLP-1 weight loss drugs, such as Ozempic and Mounjaro, unless you were overweight and had another ailment that GLP-1s can treat, such as type 2 diabetes; sleep apnea; or excess fat in the liver, a disease known as MASH.

By making GLP-1s available to more Medicare enrollees at a fixed price with fewer limitations, the bridge program is designed to bring the drugs’ immense health benefits to untold numbers of new adult Part D plan members who qualify.

“We could be talking about millions of people,” says Juliette Cubanski, vice president and director of the Program on Medicare Policy at the nonpartisan nonprofit KFF.

GLP-1s, or glucagon-like peptide-1 receptor agonists, are a class of medications created to treat type 2 diabetes by helping the pancreas release insulin when blood sugar levels are high. The medications can help with weight loss because they make you feel fuller faster.

The medications have also been shown to reduce complications from kidney disease, improve heart and liver health, treat sleep apnea in overweight adults, and even protect the brain.

But roughly 56 percent of GLP-1 users say the drugs are tough to afford, with 1 in 4 saying they are “very difficult” to afford, according to a recent KFF poll.

More than 2 out of 3 Medicare enrollees are thought to be obese or overweight based on their body mass index (BMI), an estimate of body fat based on height and weight. Thirty-four percent were classified as obese, with a BMI of 30 or greater in 2021, the Congressional Budget Office reported in 2024. Another 35 percent were classified as overweight, with a BMI of 25 to 30.

Those figures suggest that nearly 48.4 million of Medicare’s current 70.2 million enrollees could be obese or overweight.

And while 81.3 percent have Part D coverage — about 57 million people — less than 1 in 10 age 65 and older use GLP-1s, according to the same KFF poll. That’s compared to 22 percent of people age 50 to 64. The lower use among people 65 and older is likely because Medicare doesn’t cover prescriptions solely for weight loss, KFF says.

Until now, that is.

Not all Part D plan members are eligible

​“This demonstration is for beneficiaries who do not have a medically coverable indication to receive a GLP-1 through their Part D plan now,” said a CMS official during a recent webinar about the program hosted by the National Community Pharmacists Association. The pilot program “is not for beneficiaries with type 2 diabetes, obstructive sleep apnea or MASH.”

Those enrollees — and those prescribed GLP-1s to reduce the risk of heart attack, stroke or coronary bypass surgery — are ineligible for the program and can get Medicare coverage of the drugs only through their Part D plan, CMS says.

Enrollees eligible for the new program must be at least 18 years old and meet the following clinical criteria when GLP-1 treatment is started. They must have a BMI of:

• 35 or higher.
• 30 or higher and a diagnosis of chronic kidney disease at stage 3a or above; heart failure with preserved ejection fraction, when the heart pumps normally but is too stiff to relax and fill properly between beats; or uncontrolled high blood pressure despite ongoing treatment with two hypertension medications.
• 27 or higher and a diagnosis of prediabetes; previous heart attack; previous stroke; or symptomatic peripheral artery disease, when narrowed arteries reduce blood flow to the arms and legs and cause pain or cramping.

Most enrollees with Part D, including as part of Medicare Advantage and others dually eligible for Medicare and Medicaid, are in eligible plans, CMS says. They also must meet the program’s prior authorization criteria.

Program rules could prove challenging

To get medications covered under the new program, providers must submit a prior authorization request and a prescription for an eligible GLP-1 drug for an approved use. The pharmacist submits the request to the bridge program, which reviews it.

CMS is shooting for a 72-hour turnaround for prior authorization decisions. If it’s approved, the pharmacy can then fill the prescription, so the first time, patients probably won’t be walking out of the drugstore with their first month’s meds.

“Obviously, some prior authorization determinations will be made faster. Some of them, we hope, instantaneously. But we are committing to 72-hour turnaround,” a CMS official said during the webinar.

The program also requires providers to attest that a prescribed GLP-1 is to reduce excess weight and maintain weight loss in combination with lifestyle changes, including diet and exercise, CMS says.

Once the first 28- or 30-day prescription is approved through the program, subsequent ones won’t require prior authorization unless the beneficiary switches to a different covered medication, CMS says.

​“I imagine that we’ll figure it out,” Gilberg said of medical practice staff who will likely handle some of the program’s administrative requirements for providers. “But there’s so many variables, like: What kind of plan do you have? What are your diagnoses? There’s just a lot of variables that are going to have to kind of be worked through in each instance of a doctor prescribing one of these for a patient on Medicare.”

The National Community Pharmacists Association, which represents independent pharmacists, is busy making sure its members know about the program because most Medicare benefit changes typically occur in January, says Lisa Schwartz, senior director of professional affairs at the nonprofit trade group.

“Fortunately, once the prescriber completes prior authorization for the drug, the program uses routine pharmacy processes,” Schwartz told AARP. “We would encourage patients to try to have a little extra patience with their provider and the pharmacy the first month or so.”

By providing GLP-1s at a CMS-negotiated price, the bridge program will try to improve enrollees’ health and reduce long-term Medicare spending, a CMS official said.

New GLP-1 program will last 18 months

The program was conceived as a six-month bridge to a proposed Medicare pilot program that was to launch in January 2027. It would have continued the $50 copays for covered GLP-1s through participating Part D plans.

The test program, known as BALANCE, was scheduled to run in Part D through 2031 and would have covered all formulations of Mounjaro, Ozempic, Rybelsus and Wegovy, along with the KwikPen formulation of Foundayo and Zepbound.

But in April, CMS indefinitely postponed the test and extended the bridge program by a year. CMS will collect and share GLP-1 use data from the bridge program with Part D insurers and use it to decide later whether the pilot program will happen.

The BALANCE trial program did launch in Medicaid in May 2026 and is scheduled to conclude there at the end of 2031.

The bridge program and BALANCE model are among several Trump administration initiatives designed to expand access and lower the cost of GLP-1 medications.

In November 2025, the administration announced deals with Eli Lilly and Novo Nordisk to provide their GLP-1s at reduced prices. TrumpRx began offering discounted GLP-1 prices earlier this year.

Ozempic, Rybelsus and Wegovy were among 15 medications selected for Medicare drug price negotiations in 2025 that are expected to provide lower costs in 2027. Medicare spent $15.2 billion on these three GLP-1 medications in 2024.

Research suggests Medicare could spend $65.9 billion for GLP-1s over the next 10 years. However, that higher use could save an estimated $18.2 billion in health care treatment costs, resulting in a net increase of $47.7 billion. ​