Some overweight individuals with Medicare now can get a GLP-1 with a $50 monthly copay, as a result of a new pilot program. Others must pay a lot more, even if they are morbidly obese. Jackie Fortier reports for KFFHealthNews on the limits of Medicare’s new pilot.
While people sing the praises of GLP-1 drugs to treat obesity and a plethora of other health conditions, these drugs are too often unaffordable. And, under federal law, Medicare is not permitted to cover them for people simply wanting to lose weight. To understand whether the drugs could keep obese people with Medicare healthier and save Medicare money, the Centers for Medicare and Medicaid Services launched a pilot program last month to cover three GLP-1 drugs–Wegovy, the KwikPen formulation of Zepbound, and the oral medication Foundayo–for people wanting to lose weight, offering a $50 copay.
To qualify for the Medicare pilot program, people must have Medicare Part D. They also must have a body mass index of 35 or higher or a body mass index of 27 to 34 if they have prediabetes, cardiovascular disease or other specified conditions. But, if they already qualify for the drug because of a health condition that the FDA has approved GLP-1s to treat, they do not qualify for the pilot.
As a result, Medicare now discriminates against some overweight people with other health conditions who need GLP-1s. People with Type 2 diabetes and people with sleep apnea, for example, do not qualify for the pilot program. Instead, they must get their GLP-1 drugs directly through their Medicare Part D plan with copays of as much as several hundred dollars.
Here’s more from Just Care:
- Case study: Costco saves one couple hundreds of dollars over Medicare Part D
- Beginning July 2026, Medicare will cover GLP-1s for people who want to lose weight
- Daily GLP-1 pill could work as well as Ozempic
- The possible anti-cancer benefits of Ozempic and other GLP-1 drugs
- Poll: More than 10 million people with Medicare very worried about affording their drugs
