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But the temporary new benefit has some fine print Medicare recipients should know about. A new Medicare program allows some beneficiaries to get popular GLP-1 weight-loss drugs for a $50 monthly co-pay. Previously, Medicare only covered these drugs for weight-related conditions like Type 2 diabetes or heart disease. To be eligible, patients must have Medicare drug coverage and meet specific body mass index (BMI) criteria. The "bridge" program is temporary, and its extension beyond 2027 would require a change in federal law. Millions of Medicare beneficiaries could save tens of thousands a year as the Feds make a multibillion dollar bet that slimming elders’ waistlines could lighten the burden of Medicare’s costs - eventually. In a new twist, some Medicare beneficiaries can now get costly but popular GLP-1 drugs for $50 a month over the next 18 months if they are simply over a certain weight and enrolled in a Medicare plan that fits the bill.

Before July 1, 2026, Medicare was prohibited from paying for weight loss management drugs. Previous to July 2026, Medicare covered these pricey GLP-1 prescriptions only if the beneficiary also had a weight-related condition such as Type 2 diabetes, sleep apnea, high blood pressure, and cardiovascular disease among other conditions. That $50 co-pay is more than $1,000 less than the typical, monthly out-of-pocket cost for the GLP-1 brand names that Medicare is covering: Wegovy, Zepbound or Foundayo. Dr. David Liporace, a board-certified internist who works in concierge medicine at Jupiter Medical Center, said he’s "very, very excited" about the difference the new coverage could make among Medicare beneficiaries. "If we can get that population healthier from the perspective that they are more lean and more active, then they will have less heart disease, they will have less kidney disease, they will have less dementia, which is huge, and they will fall less," Liporace said, noting that GLP-1s have been shown to reduce dementia by 43% according to an analysis of multiple independent studies addressing the same research question.

Not all studies are pointing in to overall reduced medical costs, however. And the temporary, new benefit has some fine print Medicare beneficiaries should know. Is Medicare going to pay for GLP-1 drugs in 2026? What the feds are calling the Medicare GLP-1 Bridge program means that about 3.8 million Medicare beneficiaries could be eligible to get these drugs that have revolutionized weight loss in recent years for $50 a month, according to an analysis of 2023 Medicare data by KFF, a national health policy organization. The coverage was originally scheduled to expire at the end of 2026, but the "bridge" was extended to the end of 2027 months before it went into effect. Dr. Amy Sheer, who runs a weight management clinic at University of Florida Health, says she’s particularly glad to see the trial period extended - it would be hard to see the health or medical cost benefits from a six-month pilot. Usually, it takes several months for doctors to adjust the dosage to optimize effects and minimize side effects for each patient.

Most patients need time to adapt to the medication that works by slowing down digestion and boosting the pancreas’ ability to produce insulin, experience with the drugs have shown. And much patient experience has found that quitting the drugs after being on them often causes patients' weight and appetite to come roaring back. "Clinical trials are usually 52 to 72 weeks, depending on the trial and comorbidity (weight-related medical complication) so at least that gives us more time to get people to a good dose and a goal," Sheer said. How do you get GLP-1 covered by Medicare? Most Medicare beneficiaries can take advantage of the new benefit simply by going to their health care providers who will determine whether they meet the medical criteria for getting the medications for $50 a month, regardless of income. Providers will then submit the necessary prescription and prior authorization directly to the right pharmacies.

But not every Medicare beneficiary is universally eligible, however. And MedicGLP Capsules the $50-a-month cost to the program can’t be counted as part of the beneficiaries’ deductible to trigger prescription benefits. Also, those in line to get the new benefit must meet all the following specific criteria, according to a Medicare fact sheet. Have Medicare Part D coverage, either through a standalone Medicare drug plan or a Medicare Advantage plan that includes drug coverage. Beneficiaries with special plan types, like the private, fee-for-service plans or contract plans, are not eligible. Not be eligible for GLP-1 drug coverage through the current plan chosen during the latest sign-up. Those who were getting the drugs through their current plan because of a weight-related condition, for example, must keep getting their GLP-1 drugs that way. Are at least 18 years of age and meet a certain body mass index (BMI) or higher. If your BMI, according to this calculator, is lower than 35, which would be 204 pounds at 5 feet, 4 inches or 237 pounds at 5 feet, 9 inches, you must also have an attendant medical condition to qualify for the new benefit.