Does Medicare pay for GLP-1 drugs like Ozempic for weight loss? For years, the answer has been a hard no. But a new “Bridge” program upgrades the answer to something more like “yes, but …”
For the first time, starting July 1, Medicare will offer access to GLP-1 drugs like Wegovy, which has the same active ingredient as Ozempic but is FDA-approved for weight loss. Until now, Medicare has covered GLP-1 drugs like Ozempic only for certain conditions. You could get it for diabetes, for example, but not for weight loss.
The new program's best feature is pricing. Certain GLP-1 drugs will cost just $50 per month. That’s a bargain compared to Wegovy’s wholesale list price of $1,349.02. It even beats the best discounts available on GoodRx or from the manufacturer.
So what’s the catch?
There are several, actually. And they’re significant — but if you ask me, the program is probably still worth it.
The program is temporary
The new program is called the Medicare GLP-1 Bridge short-term demonstration. That “short term” is important: it lasts just 18 months. The program starts July 1, 2026, and ends Dec. 31, 2027.
After that, it’s done, and Medicare beneficiaries lose their access to $50 weight loss drugs.
That’s not how it was supposed to work.
How it was supposed to work
Originally, the short-term program was meant to be a “bridge” to a longer-term solution. Next would come the “Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth” model. (Some creative government capitalization crams that title into the acronym “BALANCE.”)
Until the Balance model went into effect, the Bridge program would’ve offered early access to $50 weight loss drugs. During its short term, the government would be on the hook for most of the bill.
Once the Balance model took effect, Medicare plans would pay for GLP-1s like other covered drugs. But if GLP-1 coverage cost more than expected, the government would cover some of the extra cost.
The Balance model was supposed to start Jan. 1, 2027.
What’s happening instead
The Balance model was voluntary and required a certain level of industry support. After the opt-in deadline for insurance companies passed in April, the Centers for Medicare & Medicaid Services (CMS) announced that it would delay the Medicare Balance model.
There is a silver lining to the delay. CMS extended the Bridge program, which would’ve wrapped up at the end of 2026, through the end of 2027. So if you want to take advantage, you’ll have access to $50 GLP-1s for the next year and a half.
It’s more like a coupon than coverage
GLP-1 drugs aren’t technically “covered” by Medicare under the Bridge program. This is a fiddly detail, but it could really matter for beneficiaries.
You need a Medicare Part D plan or a Medicare Advantage plan with prescription drug coverage to be eligible for the Bridge program. But the GLP-1 drugs aren’t part of your plan’s regular coverage. The Bridge program is its own separate thing — more like a coupon.
That means your $50 copay won’t count toward your Medicare prescription drug deductible or out-of-pocket cap. And while Extra Help subsidies can help pay for other medications, they don’t apply to GLP-1 weight loss drugs.
At $50 per month, that’s up to $600 per year in extra drug costs outside of your Medicare coverage. The lower prices could still be worthwhile, but that’s something to keep in mind for your healthcare budget.
The future outlook is iffy
The Bridge program now ends Dec. 31, 2027.
Does it have a future? And what about the Balance model? In my view, the answers depend on who — if anyone — is willing to pay.
The Bridge program’s future
CMS could extend the Bridge program again, in theory. But it would be pricey.
I asked CMS what the Bridge program will cost taxpayers. Its spokesperson didn’t provide that information.
That’s not going to stop this data nerd. I took a look at what Medicare spends on the non-weight-loss versions of two Bridge program drugs: Wegovy and Zepbound. (The third, Foundayo, just got FDA approval in April, so it’s too new for spending data.)
In 2024, Medicare spent over $19.3 billion on Ozempic and Mounjaro, according to gross spending data from CMS. Those are the non-weight-loss versions of Wegovy and Zepbound, respectively.
Among all covered drugs, Medicare spent the second-most on Ozempic. Mounjaro came in fourth.
So even before covering GLP-1s for weight loss, they’re costing Medicare a ton of money.
There are about 14 million Medicare beneficiaries with obesity, according to the Department of Health and Human Services. Continuing to cover weight loss drugs for even a small portion of them could easily add billions per year to an already strained budget.
I’d expect CMS to try for a model where insurance companies shoulder at least some of the cost, instead.
Will there be a Balance model?
The cost of covering GLP-1s is likely a concern for Medicare plans, too. Many insurance companies are dropping non-Medicare coverage for the drugs.
CMS didn’t officially state that not enough companies opted in for the Balance model. A CMS spokesperson said in an email that the delay was “to allow data collection that will support a more effective potential implementation.”
When I asked, CMS didn’t provide details about the future prospects for the Balance model or how it’s currently working with insurance companies.
I also reached out for comments on Bridge and Balance from many of the largest Medicare companies. Those who got back to me largely echoed CMS’ response.
A UnitedHealthcare spokesperson said in an email that the company looks forward to learning from the Bridge program and applying insights to “a potential Balance program in the future.” Aetna, similarly, praised the extension of the Bridge program and said it would use program data to plan for future GLP-1 coverage.
Should you get GLP-1s through the Bridge program?
I can’t tell you whether GLP-1 weight loss drugs are a good fit for you medically. That’s a discussion to have with your doctor.
But if you’re in the market, the Bridge program’s $50 price tag is a great deal. Government data shows that Medicare beneficiaries without Extra Help subsidies pay over $100 per month for Ozempic when plans cover it for diabetes or other health conditions, for example. (And you’d pay considerably more if your plan doesn’t cover it at all.)
But keep the caveats in mind: The $50 price tag needs to fit into your budget, separate from your Part D coverage. And the program probably won’t last forever, so you might need to rethink that budget after 2027.
Full disclosure: I take Wegovy myself, even though my health insurance doesn’t cover it. I get a pretty good deal through my Costco pharmacy, but I still pay a lot more than $50 per month. I don’t qualify for Medicare, but if I did, I’d take full advantage of the Bridge program’s low prices for as long as it lasts.
The article Medicare’s New GLP-1 Weight Loss Program Is Complicated but Worth It originally appeared on NerdWallet.
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