Starting July 1, millions of Medicare beneficiaries will gain access to GLP-1 weight-loss medications such as Ozempic and Wegovy at a reduced copayment of $50 per month under a new government pilot program. The Medicare GLP-1 Bridge program, set to run through 2027, targets up to 14 million overweight Medicare recipients, expanding access to these drugs beyond their previous use for conditions like diabetes and cardiovascular disease.

The initiative stems from a drug pricing agreement announced last November by President Trump, aimed at significantly lowering costs for Americans by securing GLP-1 medications at a "most favored nation" pricing rate. Currently, retail prices for these drugs are substantial: Ozempic costs over $1,000 monthly, while Wegovy, the formulation specifically approved for weight loss, is priced at approximately $1,350 per month. Generic alternatives are not available due to patent protection on these relatively new medications.

Under the pilot, Medicare patients aged 65 and older with a body mass index (BMI) of 35 or more will automatically qualify. Those with a BMI of 27 or higher may also be eligible if they have obesity-related health conditions such as prediabetes or heart disease. Eligibility requires enrollment in Medicare Part D, the prescription drug coverage plan. However, patients already receiving GLP-1 prescriptions through Medicare for other medical indications may not be eligible for the reduced copay offer.

The program includes three GLP-1 drugs: Zepbound, Foundayo, and Wegovy. Unlike the injectable forms of some GLP-1s, Foundayo and Wegovy are available in pill form. Cash prices for these drugs vary, with Zepbound typically costing $699 monthly and Foundayo up to $349. Participants will obtain prescriptions through a streamlined prior-authorization process handled via the Humana platform, allowing any licensed physician—not just Medicare providers—to authorize the medications.

This pilot is designed to test both demand and the feasibility of integrating GLP-1 weight-loss treatments into Medicare on a larger scale, potentially paving the way for a permanent program beginning in 2028. Insurer participation is crucial for the program’s sustainability, as private payers would share in subsidizing the reductions in drug costs. Without sufficient insurer buy-in, the government could face substantial expenditures. The Congressional Budget Office estimates that running such a program from 2026 to 2034 could cost taxpayers roughly $35 billion.

While critics caution that the pilot focuses solely on medication affordability and does not address essential lifestyle changes like diet and exercise, proponents argue that investing in weight-loss treatments may reduce long-term healthcare costs by improving population health. As this pilot progresses, outcomes and insurer engagement will likely shape the future of GLP-1 coverage under Medicare.