CMS unveils $50 GLP-1 prescriptions for Medicare patients
The Centers for Medicare & Medicaid Services announced Wednesday that it has developed a framework for Medicare beneficiaries to seek the benefits of GLP-1 diabetes and weight loss medications and have the costs covered—albeit for an additional monthly premium above and beyond the standard cost of insurance.
Prior to this switch, GLP-1 drugs were not covered by traditional Medicare at all, leaving patients seeking the popular drugs to rely on supplemental insurance or cash price discounts. In general, depending on the medical need, commercial insurance and Medicare Advantage plans have also been hesitant to cover the cost of GLP-1s, given they are primarily used for weight loss and carry a hefty price tag.
Beginning on July 1, seniors on Medicare can pay $50 a month to access GLP-1 medications similar to brand names like Wegovy and Ozempic, benefitting them whether they’re looking to shed pounds or control their blood glucose levels.
The extended coverage program, CMS confirmed, will extend through December 31, 2027. The initiative has been dubbed “Medicare GLP-1 Bridge.”
“GLP-1s can be life-changing for patients managing obesity and related conditions,” Chris Klomp, Director of Medicare and Chief Counselor at the U.S. Department of Health and Human Services (HHS), said in a statement. “This demonstration is designed to make accessing those medications simpler, more predictable, and more consistent across the Medicare program, which means better quality of life for seniors and better value across the healthcare system.”
Notably, the $50 option only applies to Medicare beneficiaries who have signed up for Part D, the federal government’s prescription drug coverage program. Those eligible will receive more information from CMS once the GLP-1 medications become available, the agency confirmed.
‘Bridge’ operates at the behest of RFK
CMS added in its announcement that Medicare GLP-1 Bridge is made possible by authorities granted to HHS Secretary Robert F. Kennedy, Jr., who has the ability to test new methods for patient care delivery via Medicare.
CMS is then empowered to effectuate these initiatives, working with providers and pharmacies to develop the logistics necessary to make these drugs available to Medicare patients. CMS Administrator Mehmet Oz, MD, expressed his support for the measure.
“These treatments are a major medical advancement, but too many seniors are currently unable to access them due to high cost,” he said. “The Medicare GLP-1 Bridge changes that by making these medications more affordable and accessible, while advancing our broader goal of helping Americans live healthier lives.”
Everything begins in July.
For more information, read the full details of GLP-1 Bridge by clicking here.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.