WASHINGTON — Medicare will begin covering weight-loss drugs for the first time in its history on 1 July through a temporary pilot programme called Medicare GLP-1 Bridge, potentially making medications such as Wegovy and Zepbound available to millions of older Americans at a fraction of their current cost. Eligible enrollees will pay $50 for a month’s supply, a steep discount from the hundreds or thousands of dollars many currently pay out of pocket. The programme, announced as part of a deal the Trump administration struck with drugmakers Eli Lilly and Novo Nordisk in November, will run through the end of 2027. It was originally designed as a six-month stopgap but was extended to 18 months after not enough Part D insurers signed up for a longer-term pilot.

The coverage is limited to Medicare beneficiaries who meet specific health criteria and are enrolled in a Part D drug plan. Those who qualify must obtain a prescription from their doctor and complete a prior authorisation form. The programme covers Wegovy tablets and injections, Zepbound KwikPens, and Foundayo tablets. It does not cover single-dose Zepbound vials or pens.

Who Is Eligible

The programme is not universal. Enrollees must meet specific body mass index thresholds and, in some cases, have additional health conditions.

Those with a BMI of 35 or more qualify directly. Those with a BMI between 30 and 35 must also have at least one of the following: uncontrolled high blood pressure, prediabetes, a previous heart attack or stroke, blocked arteries in the arms or legs with symptoms, chronic kidney disease at Stage 3a or higher, or diastolic heart failure. Those with a BMI between 27 and 30 must also have either prediabetes, a previous heart attack or stroke, or blocked arteries in the arms or legs with symptoms.

Enrollees are not eligible if they already receive GLP-1 medications through their Medicare Part D drug plan for other conditions, or if they have type 2 diabetes, moderate to severe sleep apnea, or fatty liver disease—conditions that may already qualify them for coverage through other channels.

KFF, a health policy research group, estimates that 3.8 million beneficiaries—about 8% of Part D enrollees—could be eligible. CMS has not disclosed its own enrolment projections. Chris Klomp, the agency’s Medicare director, said last week that participation would likely be in “single-digit millions initially.”

According to CMS documentation on the Medicare GLP-1 Bridge programme eligibility criteria and coverage parameters, the programme requires a prior authorisation form completed by the prescribing doctor.

As our analysis of Medicare Part D coverage expansion and pharmaceutical access has tracked, the prohibition on Medicare covering weight-loss drugs has been in place since the programme’s creation. The Bridge pilot represents the first exception.

The Cost

Under the agreement with Eli Lilly and Novo Nordisk, Medicare will pay $245 for a month’s supply of the medications. Enrollees will pay a $50 copay. That copay does not count toward their annual deductible or out-of-pocket maximum.

For many seniors, the savings are transformative. Mary Abrahamson, 71, of rural Washington, has been paying $200 a month for a compounded version of tirzepatide. She and her husband, Jeff, 77, hope to qualify for Zepbound at $50 a month each. “With this weight loss, I feel 10 years younger,” she told CNN. The extra weight had made it harder for her to walk her dogs and garden. The drug resolved her sleep apnea.

Deb Cooperman, 65, of New Jersey, has been paying $450 a month for Zepbound for just over a year, shedding 30% of her body weight. “Do I want to see a play, or do I want to have this medication that has regulated something that has tortured me since I was a teenager?” she said. “I want to take the medication. I can skip the play.”

Juliette Cubanski, director of the Programme on Medicare Policy at KFF, noted that even $50 a month can be a barrier for some seniors on fixed incomes. Beneficiaries who qualify for Medicare’s Extra Help programme for low-income enrollees must still pay the $50 charge.

According to KFF analysis of Medicare GLP-1 Bridge eligibility and cost projections, if 10% to 25% of eligible enrollees participate and fill monthly prescriptions through the end of 2027, it would cost Medicare between $1.3 billion and $3.3 billion—though that does not account for potential savings from improved health outcomes.

How Long Does It Last

The Bridge programme runs through the end of 2027. It was originally conceived as a six-month pilot before transitioning to a longer-term programme called the Balance model. Not enough Part D insurers signed up for Balance, prompting CMS to extend Bridge to 18 months.

The underlying law has not changed. Medicare is still prohibited from covering weight-loss drugs. The Bridge programme exists under CMS’s authority to run short-term demonstration projects. The agency is collecting data for a potential future launch of the Balance model, but insurer participation remains uncertain.

Brian Reid, principal of Reid Strategic, a pharmaceutical consulting firm, said it is not clear that insurers will sign up for Balance even after seeing the Bridge data. “There will either have to be a big carrot or a big stick to get the insurers to participate,” he said.

The Congressional Budget Office previously estimated that expanding weight-loss drug coverage would cost the federal government $35 billion between 2026 and 2034, with only small savings from improved health. Klomp told the Aspen Institute that CMS believes Bridge will be cost-neutral over 24 months and “a material cost-saver” when health improvements are included.

As our coverage of GLP-1 drug pricing and the pharmaceutical market has documented, the cost of these medications has been the central barrier to broader insurance coverage. The Bridge programme’s $245 negotiated price represents a significant discount from the $1,000-plus list prices.