Millions of Medicare Part D recipients could soon gain access to GLP-1 medications commonly used for weight loss through a pilot program that could save some seniors thousands of dollars per year.
According to KFF, about 4 million Americans now meet the criteria for Wegovy, Zepbound and Found. The medications would cost participants about $50 per month. The list price for these drugs can climb above $1,000 per month. The pilot program runs through the end of 2027 and does not replace current law, which bars Medicare and Medicaid from covering GLP-1 medications prescribed solely for weight loss.
To participate in the program, you are not allowed to be eligible for a GLP-1 through your current Medicare drug plan.
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Current Food and Drug Administration approvals allow the medications to be prescribed to people with a body mass index, or BMI, of 30 or higher. People with a BMI of 27 or higher may also qualify if they have a weight-related condition such as heart disease or high blood pressure.
The pilot program is more restrictive. Subsidies are available only to people with a BMI higher than 35. People with a BMI of 30 or higher may also qualify if they have a weight-related condition. Those with a BMI of 27 or higher may qualify if they have a condition linked to prediabetes.
Currently, Medicare Part D recipients with Type 2 diabetes are eligible to have the drugs covered.
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Despite the expanded access, nearly 6 million Medicare Part D recipients who would otherwise qualify for the medications will not be eligible for the pilot program.
Some researchers have raised concerns that GLP-1 medications may contribute to bone and muscle density loss in seniors because of rapid weight loss. That can increase the risk of falls and related injuries.
Medical professionals, however, say exercise and strength training can help reduce bone and muscle loss.