{
  "id": 3355081,
  "title": "The Medicare GLP-1 discount is here, so why are some sick people excluded?",
  "url": "https://urgent.news/2026/08/25/the-medicare-glp-1-discount-is-here-so-why-are-some-sick-people",
  "topic": "health",
  "section": "Health & Medicine",
  "published": "2026-08-25T21:25:57.000Z",
  "source": {
    "name": "Fortune",
    "slug": "fortune",
    "url": "https://fortune.com/2026/08/25/the-medicare-glp-1-discount-is-here-so-why-are-some-sick-people-excluded/"
  },
  "original_language": "en",
  "account": "The Medicare GLP-1 discount program, launched in January, aims to make popular weight loss drug Zepbound more affordable for some Medicare enrollees, with a monthly price of only $50. However, the eligibility criteria for this pilot program have sparked controversy, with some patients excluded even though they have severe medical conditions.\n\nJeff La Marca, a 68-year-old resident of Basking Ridge, New Jersey, is among the estimated 5.9 million Medicare members who are excluded from the program due to a medical condition like Type 2 diabetes or sleep apnea. Despite having a BMI of 42 and having undergone quadruple heart bypass surgery, La Marca is denied the $50 monthly price for Zepbound, instead facing higher out-of-pocket costs through his Medicare Part D prescription drug plan.\n\nThe Bridge program, a 18-month pilot, aims to test if subsidizing GLP-1 medications for weight loss will save Medicare money in the long run. Eligible patients must be enrolled in Medicare Part D and have a BMI of at least 35, or a BMI of 27 to 34 with qualifying medical conditions. However, patients with conditions such as Type 2 diabetes or moderate to severe obstructive sleep apnea, which are FDA-approved for GLP-1 treatments, are instead routed back to their Part D plan, often facing higher copays.\n\nCritics argue that the program leaves behind patients with the greatest medical need, who already face steep out-of-pocket costs and prior authorization hurdles. While the program's initial weeks have been positive, the full cost impact remains uncertain, with estimates ranging from $3.3 billion to $10 billion depending on enrollment levels.",
  "summary": "“I'm obese, morbidly obese, BMI 42. I had quadruple heart bypass surgery. I'm at risk for stroke. I'm prediabetic. And yet I can't get it. I'm livid.\"",
  "key_points": [],
  "editors_take": null,
  "illustration": null,
  "coverage": {
    "outlets": 1,
    "also_reported_by": []
  },
  "ai_generated": true,
  "disclaimer": "Summaries, key points and the editor’s take are written by software from other outlets’ reporting and may contain errors — always check the linked original."
}