The Medicare GLP-1 discount has one big catch: Some sick patients don't qualify
About 1 in 5 American adults have taken a GLP-1 medication, and most of them, including those with health insurance, say the drugs are difficult to afford. Federal law has long barred Medicare from covering drugs prescribed solely for weight loss, which is why the Medicare GLP-1 Bridge program made a big splash when it launched in July.
The Medicare GLP-1 Bridge program offers $50 coverage for certain weight-loss medications, but it leaves out patients who use the drugs for FDA-approved conditions such as type 2 diabetes or sleep apnea. These patients must rely on their Medicare Part D plans, which may require expensive copays of $200–$600 per month. The program aims to help patients with a BMI of 35 or higher, or those with a BMI of 27 to 34 and specific health conditions, access GLP-1 medications.
However, the cost-sharing structure under Part D can make these drugs unaffordable for many beneficiaries, potentially leaving them worse off than before.
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