Medicare will start covering obesity drugs for the first time. Here's what patients should know

Millions of older Americans in Medicare are about to receive a benefit that has never existed before: coverage of obesity drugs.

Starting Wednesday, eligible beneficiaries can get GLP-1s to treat obesity for a copay of just $50 per month. It's a watershed move that could unlock a vast new patient population for Novo Nordisk and Eli Lilly and dramatically expand access to medications that were previously out of reach for many people ages 65 and above.

Medicare Part D, or prescription drug plans, already cover some GLP-1s for conditions like diabetes and cardiovascular disease, but federal law has banned coverage solely for obesity. Medicare's new Bridge demonstration program sidesteps that law to cover the drugs for obesity – at least temporarily – for more beneficiaries, including those who are overweight with conditions like prediabetes or uncontrolled hypertension.

There were more than 69 million beneficiaries in Medicare as of about a week ago, and "several million" are expected to access the drugs through the Bridge program, said Chris Klomp, director of Medicare and deputy administrator of the Centers for Medicare and Medicaid Services, during the Aspen Ideas Festival last week.

There are also many more patients to capture: Roughly 15 million to 20 million older adults in Medicare are estimated to qualify for weight loss drugs, according to Novo and Lilly.

But the initial rollout may not be smooth. Providers must submit prior authorization requests to attest that patients meet eligibility requirements, a process some physicians said may be cumbersome. Some doctors also worry the new coverage could spark a surge in demand that will strain busy clinics and pharmacies, and others raised concerns about a lack of broader public awareness of the program.

There's also a larger question hanging over the Medicare breakthrough: Unless the Trump administration extends or replaces the demonstration program, obesity drug coverage is scheduled to expire at the end of 2027. Covering the drugs permanently would require a change in federal law or at least agreement among private health insurers to provide the medications in Part D plans.

That creates uncertainty for patients who may begin treatments that many experts view as lifelong therapies.

"It's good news that Medicare is rolling out this program, but it is temporary, so it's really not clear at this point what happens after the end of the 18-month program duration," said Juliette Cubanski, director of the Program on Medicare Policy at KFF, a health policy research organization. "Whether that coverage will continue in some other fashion, or whether people might lose access at that point."

The $50 monthly copay is significantly less than what patients without any insurance coverage for obesity drugs typically pay. That price also applies to all doses rather than increasing with a larger dosage, as it does for people paying out of pocket.

Lilly and Novo have both rolled out sweeping cash discounts for their respective drugs for patients willing to pay out of pocket, but those prices can still be unaffordable for some people.

Novo's Wegovy injections range in price from $199 for a lower dose for the first two months under a limited-time offer, to $399 for the newly launched highest dosage. The KwikPen and single-dose vial formulations of Lilly's Zepbound cost from $299 to $699 per month, depending on the dose. At the highest dosages, Novo's daily Wegovy pill costs $299, while Lilly's rival Foundayo tops out at $349.