AARP Hearing Center
Medicare’s $50 GLP-1 Program Coincides With Rise in Weight Loss Prescriptions for Older Adults
What you should know about eligibility for Medicare’s 18-month GLP-1 Bridge program
Sjoerd van Leeuwen
Key takeaways
- GLP-1 prescriptions jumped after Medicare program launch.
- Nearly 4 million beneficiaries could get GLP-1s for $50.
- Participants must be enrolled in a Medicare Part D plan.
- Coverage determinations are taking about 12 hours.
More than 500,000 Medicare beneficiaries who are overweight have signed up to receive $50 monthly supplies of GLP-1 weight loss medications under an 18-month pilot program that launched in July, the White House says.
The actual number could be as high as 600,000, says Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services (CMS).
More Ways to Benefit
- Related Benefit 1
- Related Benefit 2
- Related Benefit 3
- Related Benefit 4
- Related Benefit 5
The strong debut of the Medicare GLP-1 Bridge program preceded a 19 percent jump from June to July in the share of older adults who had received a GLP-1 prescription, according to new research from Truveta, a health data and analytics company.
It’s the largest month-to-month increase observed over seven years of data on GLP-1 prescriptions among adults age 65 and over, says Karen Farrar, a senior research analyst at Truveta.
While the preliminary data does not establish that the Bridge program caused the rise, “what we can say is that we’re seeing an immediate increase in prescribing following the implementation of the program, which, to me, speaks about how policies that are designed to remove financial barriers can have an immediate impact on medication access,” Farrar says.
Early Bridge program participants have met specific medical requirements and were deemed eligible to receive reliable GLP-1 coverage at a fixed price to help them “get back to their healthy fighting weight” or “the weight you were as a young adult when you had all the hormones working in your favor,” Oz said on the eve of the program launch in June.
The Bridge program, which runs through December 2027, offers monthly supplies of Wegovy injections and tablets, Foundayo tablets and the Zepound KwikPen for $50 to help eligible beneficiaries lose weight and maintain weight loss. CVS Pharmacy says it has filled more than 100,000 prescriptions through the program.
Continued enrollment growth eyed for Bridge program
After enrolling roughly 250,000 people in July, program participation topped 500,000 by the end of August, as beneficiaries saved $216 million on the popular but costly medications, the White House reported on Aug. 31.
During a White House press briefing the same day, Oz said Bridge program enrollment had reached 600,000.
“We project we’ll actually be able to save money for the taxpayer because the savings aren’t only in dollars, they’re in saved lives,” Oz said. “Less hospitalization, less complications from high blood pressure, diabetes and all the ravages of obesity because we’ve got prices where they need to be.”
Continued strong enrollment growth is possible as patients and providers become more familiar with the program, says Leigh Purvis, prescription drug policy principal at AARP’s Public Policy Institute.
“This program is kind of unique since it operates outside Medicare prescription drug coverage and requires people to work with their health care providers to determine whether they’re eligible,” Purvis says.
Unlike GLP-1 coverage offered through Medicare’s Part D prescription drug benefit, Bridge program enrollees can get the medications without being diagnosed with another ailment that the drugs can treat, such as type 2 diabetes, sleep apnea or the fatty liver disease known as MASH. The Medicare Prescription Drug Improvement and Modernization Act of 2003 prohibits Part D plans from covering antiobesity medications as part of the standard prescription drug benefit.
That’s why the Bridge program could cover some 3.8 million beneficiaries who probably wouldn’t qualify for GLP-1 coverage through their Part D plan, according to KFF, a nonprofit health research organization.
Drugmakers, others help raise program awareness
“We’re proud to work with CMS to broaden access for older Americans through the Medicare GLP-1 Bridge program,” says a spokesperson for Novo Nordisk, makers of Wegovy. “That includes meeting patients where they are” to help them “understand eligibility requirements, navigate the program and access the care that’s right for them.”
Pharmacies, insurers and groups like the Patient Advocate Foundation are also helping spread the word. The foundation, a national nonprofit that provides financial assistance to patients, has an educational webpage about the Bridge program. The group has promoted the webpage in its newsletter, which reaches nearly 400,000 people, says Caitlin Donovan, senior director at the foundation.
But not every Medicare beneficiary who is overweight can participate in the program. And even though Bridge is not a Part D program, beneficiaries must have eligible Part D coverage to participate.
To help sort through the Bridge program’s complex eligibility and participation requirements, AARP answers some frequently asked questions.
Eligibility for $50 GLP-1 program can be tricky
Q: Should I talk to my Part D plan provider to see if I’m eligible for the Bridge program?
A: No. Talk to your health care provider instead, because the Bridge program isn’t a Part D offering. Your provider will help you determine whether your Part D coverage, weight and medical conditions make you a potential candidate or not. Your provider must submit a prior authorization request to have their GLP-1 prescription covered under the Bridge program. Humana will make the call.
Q: So who’s eligible and who isn’t?
A: It’s complicated. But generally, Bridge participants must have eligible Part D coverage through a stand-alone plan or a Medicare Advantage plan with drug coverage. If you have questions about what type of Part D plan you have, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
Those eligible to receive a GLP-1 through their Part D plan because they also have type 2 diabetes, moderate to severe sleep apnea or MASH are not eligible for the Bridge program. In addition, Bridge participants must be at least 18 years old and have a program-eligible body mass index, or BMI, an estimate of body fat based on your height and weight. Your doctor can tell you what your BMI is.
Bridge program participants must have a BMI of either:
- 35 or higher
- 30 or higher with chronic kidney disease at stage 3a or above, certain types of heart failure or uncontrolled high blood pressure, or
- 27 or higher with prediabetes, a previous heart attack, a previous stroke or blocked arteries in your legs or arms.
Q: If I get turned down for the Bridge program, can I appeal the decision?
A: No. “There won’t be a formal appeals process,” says a CMS official. However, if your provider submits an authorization request with inaccurate information, or if they have new information pertinent to a coverage decision, they can update and resubmit the request. And beneficiaries can appeal GLP-1 coverage decisions issued under the Part D benefit.
Q: If I can’t enroll in the Bridge program and can’t get a GLP-1 through my Part D plan, where can I get help paying for the medication?
A: If you can’t afford to pay the full cost out-of-pocket — note that lower prices are available on drug manufacturers’ websites, some of which are linked through the TrumpRx website — other options include: some employer health insurance plans, some retiree health insurance plans, patient assistance programs and tax-free money from a health savings account, if you have one.
Q: If we’re paying only $50 for a monthly dose of GLP-1s, how much is Medicare paying? What’s the actual cost of the medications?
A: Medicare negotiated a monthly price of $245 for the three GLP-1s offered in the Bridge program. Beneficiaries pay a $50 copay toward that price, which means Medicare pays $195 of the actual per-dose cost.
How long do program coverage decisions take?
Q: Medicare was aiming for a 72-hour turnaround for prior-authorization decisions on whether a prescribed medication will be covered by the program. How’s that timeline working out?
A: The pilot program has generally met the 72-hour threshold, with most prior-authorization determinations completed in under 12 hours. Although some prior-authorization requests are submitted by fax, most are submitted electronically. CMS encourages electronic submissions to speed up the process.
Q: Did the data on the July spike in GLP-1 prescriptions for people 65 and older indicate which of the Bridge program GLP-1s (Wegovy, Zepbound and Foundayo) saw the largest increase?
A: The percentage of older adults with a prescription for tirzepatide (Zepbound) showed an 80 percent relative increase from June to July, Farrar says. The share of older adults with a prescription for semaglutide (Wegovy) increased 40.9 percent. There was not enough data to measure for orforglipron (Foundayo), a relatively new medication that recently entered the market. It represents about one-tenth of 1 percent of all adult prescriptions for GLP-1s, Farrar says.
Q: I haven’t heard or seen much advertising for the Bridge program. Why haven’t we seen more to promote it?
A: CMS did “limited public outreach” on the Bridge program ahead of the July launch “because beneficiaries are most moved to take action when they are actually able to take action,” a CMS official explained at a recent press briefing. “We’ll begin more promotions” as the program gets underway “in the interest of being good stewards of our taxpayer dollars,” the official said. CMS will continue to provide information and educational resources about the program to beneficiaries, providers, pharmacies and other stakeholders. More information about the program is available on the CMS website or by calling 1-800-MEDICARE.
Drugmakers Eli Lilly and Novo Nordisk, makers of Wegovy, Zepbound and Foundayo, have begun steady promotions for the program. Both companies have Facebook reels that tout the Bridge program.
Websites for all three medications also mention the Bridge program. So do television commercials for Foundayo and Zepbound. A Wegovy commercial cites Medicare’s $50 per month coverage but doesn’t mention the Bridge program by name.
Join Our Fight to Protect Medicare
AARP is working to keep Medicare strong. Here’s how you can help.
- Sign up to become an AARP activist for the latest news and alerts on issues you care about.
- Find out more about how we’re fighting for you in Congress and across the country.
- See the latest AARP research on Medicare.
- AARP is your fierce defender on the issues that matter to people 50-plus. Become a member or renew your membership today.
AARP Membership
Join AARP for only $15 per year with automatic renewal. Get instant access to members-only products and hundreds of benefits, a free second membership, and a subscription to AARP The Magazine.
More From AARP
Program’s End Could Raise Medicare Premiums
2027’s Part D out-of-pocket spending cap will remain in place
Medicare Now Offers $50 GLP-1s for Weight Loss
Millions of enrollees may be eligible if not on it already
5 Smart Money Moves to Make Before Medicare
Before 65 is important for financial, health care planning