For The First Time In History Medicare Is Covering Weight Loss Drugs And The Price Is $50 A Month
Starting July 1, eligible Medicare enrollees will be able to access GLP-1 weight loss medications including Wegovy, Zepbound, and the newer drug Foundayo for a flat $50 monthly copay, in a historic first for the program, which has never before covered anti-obesity medications despite covering many of the serious health conditions that obesity contributes to. The initiative, called the Medicare GLP-1 Bridge, is a pilot program run by the Centers for Medicare and Medicaid Services that will operate through December 31, 2027, offering a consistent $50 monthly copay that does not increase with dosage. Without the program, these medications carry retail prices that often exceed $1,000 per month, and a recent survey found that more than half of GLP-1 users described them as difficult to afford even when they had some coverage. CMS Administrator Dr. Mehmet Oz said the Bridge changes that by making medications that are a major medical advancement accessible to seniors who were previously priced out.
To qualify, Medicare enrollees must be enrolled in a Part D prescription drug plan and meet clinical criteria: a BMI of 30 or higher, or a BMI of 27 or higher combined with a qualifying condition such as heart disease, prediabetes, high blood pressure, chronic kidney disease, or sleep apnea. Both injectable and pill forms of the eligible drugs are covered, which is significant because many older adults find injectables difficult to use due to arthritis or other physical limitations. There are trade-offs worth knowing: the $50 copay does not count toward the Part D deductible or the $2,100 annual out-of-pocket cap, and low-income subsidy benefits cannot be applied to Bridge prescriptions. Beneficiaries who want to explore eligibility should speak with their doctor before July 1, since prior authorization will be required.
Source:https://abcnews.com/GMA/Wellness/medicare-enrollees-glp-1-drugs-50-starting-july/story?id=132738089
