Medicare GLP-1 Pilot Program Aims to Reduce Costs for Seniors
Kathryn, a 66-year-old retiree from Denver, Colorado, who has worked in healthcare, has experienced "cyclical weight-loss, weight-gain" throughout her life.
"Every time that that has happened, it’s been a little bit greater of the loss and the gain, which is really unhealthy,"
said Kathryn, who requested only her first name be used. At her heaviest, the 5ft 1in woman weighed 220lbs.
Like millions struggling with obesity, Kathryn began taking a GLP-1 drug about two years ago, which helped her break the cycle. She now weighs 133lbs.
"My blood pressure is great; my cholesterol is great. I feel really good,"
she said.
However, the health benefits come with a significant financial burden. Kathryn uses Zepbound, an injectable GLP-1 drug costing $450 per month, which has limited her ability to travel in retirement. Recently, she has been stretching out dosages to make each order last longer than a month.
Financial relief may be forthcoming. On 1 July, the Centers for Medicare & Medicaid Services (CMS) will launch a pilot program allowing some adults aged 65 and older to pay only $50 monthly for a GLP-1 drug.
Medicare GLP-1 Bridge Program Could Help Millions
Doctors treating obesity believe the Medicare GLP-1 Bridge initiative could assist millions of older adults who struggle to afford these medications or have been unable to start treatment due to cost. However, questions remain about the federal government's administration of the program, which is temporary.
"It’s a huge social and healthcare experiment to have this volume of people that are going to rely on the CMS website working; the pharmacy side working and the health system side all being able to process these prior authorizations in an efficient, effective way,"
said Dr. Annie Moore, an internist at CU Health in Denver.
"This has never happened. I just don’t quite know how smooth it’s going to be."
By fall 2025, approximately 5 million U.S. adults aged 65 and above—those covered by Medicare—were taking a GLP-1 drug for weight loss or chronic conditions such as diabetes, according to a recent report.
"They are super popular for a reason: they work really well,"
said Dr. Christopher Weber, an internist in Milwaukee who treats patients with obesity.
Still, seniors are more likely than younger adults to discontinue these drugs, partly due to cost.
Program Details and Eligibility
The Medicare GLP-1 Bridge program will cover three drugs: Foundayo, Wegovy, and Zepbound. It will be available to individuals with Medicare Part D, an optional prescription drug coverage plan. Eligible participants cannot have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease, as these conditions may already be covered by their drug plan. Additionally, participants must have one of three qualifying conditions, including a body mass index (BMI) of 35 or higher.
Dr. Weber noted that clinics are expected to be busy with new patients seeking GLP-1 drugs.
"If [patients] want to start taking a GLP-1, the clinics are going to be busy,"
he said.
"It’s a process for these prior authorizations, so just keeping up with that demand and the administrative overhead is going to be a challenge."
Despite the program's launch, Dr. Moore estimates it may take three to four months before patients can access GLP-1 drugs at the $50 price point.
"I think there is going to be a lot of frustration, particularly in our patients that are already paying cash because they know the benefits"
of GLP-1 drugs, Moore said. She added that many older adults have limited incomes, and
"we still have a concern that some people will find $600 per year too expensive."
Concerns Over Program Duration and Future
The Bridge program is scheduled to run until the end of 2027, raising concerns among providers about what will happen if it is not extended. Patients often regain weight after stopping GLP-1 treatment.
"It’s a temporary program; obesity is not a temporary problem,"
said Dorothea Vafiadis, senior strategist for healthy aging at the National Council on Aging. Regarding the program's status post-2027, she noted,
"people are scratching their heads, saying: ‘What will I do then?’"
Meanwhile, physicians like Moore and Weber hope the program will enable more patients to begin GLP-1 treatment. Dr. Weber mentioned that he speaks daily with at least five patients who could benefit from GLP-1 drugs but cannot afford them.
Personal Stories Highlight Impact
Carmin, another Denver resident who works in healthcare, shared her experience. She was teased about her weight as a child and has experienced six 150-lb weight swings in her life. Although interested in trying a GLP-1 drug, she had not pursued it due to saving for retirement. She now hopes to benefit from the Bridge program.
"The dream scenario for me is that by Christmas or next spring,"
Carmin said,
"I can get back into clothes I was wearing two years ago."
