Medicare begins covering weight-loss medications: who qualifies and how the new program will work

For years, many older Americans with obesity watched as medications like Wegovy and Zepbound revolutionized weight-loss treatment yet remained out of their reach due to their high cost and Medicare restrictions. Starting July 1, 2026, that will change thanks to a new temporary program that will provide access to these treatments for a copay of $50 per month.

The initiative, called the Medicare GLP-1 Bridge, marks the first time Medicare has covered prescription drugs used exclusively to treat obesity — form of coverage that until now was only available when these drugs were used to treat conditions such as type 2 diabetes or certain cardiovascular problems.

How does the new program work?

The pilot program will run from July 1, 2026, through December 31, 2027. During that period, eligible Medicare beneficiaries with Part D coverage will be able to access weight-management medications for a fixed copay of $50 per month.

Included treatments include Novo Nordisk’s Wegovy, available in both injectable and tablet forms, as well as Eli Lilly’s Zepbound KwikPen and Foundayo. The program does not cover single-dose formulations of Zepbound.

Although the price represents a significant savings compared to the usual cost of these medications — which can exceed several hundred dollars a month — the copayment will not count toward the Medicare deductible or the beneficiary’s annual out-of-pocket maximum. It will also not be possible to use coupons or additional discounts to reduce that amount.

Who is eligible for coverage?

Being enrolled in Medicare is not enough to receive this benefit. Patients must meet a series of clinical requirements and obtain prior authorization.

The treating physician must submit the prescription, complete the required documentation, and certify that the patient is participating in a lifestyle modification program that includes healthy eating and exercise.

The eligibility criteria cover three main groups:

• People with a body mass index (BMI) of 35 or higher.
• Patients with a BMI of at least 30 who also have heart failure, uncontrolled hypertension, or certain chronic kidney diseases.
• People with a BMI of 27 or higher who have prediabetes, a history of heart attack or stroke, or symptomatic peripheral artery disease.

Those who already receive coverage for GLP-1 medications through Medicare for other approved indications, such as type 2 diabetes, sleep apnea, or fatty liver disease, will not be eligible.

Estimates suggest that approximately 3.8 million beneficiaries will initially meet the program’s eligibility requirements, although pharmaceutical companies estimate that between 15 and 20 million older adults could meet the clinical criteria for these treatments.

Concerns

Although GLP-1 medications have proven effective for weight loss, medical specialists warn that older adults require closer monitoring.

One of the main risks is the simultaneous loss of fat and muscle mass, a problem that can increase the frailty associated with aging. To reduce this effect, specialists recommend combining the treatment with strength training and a protein-rich diet.

There is also concern about a possible decrease in bone density, especially among postmenopausal women and people at higher risk for osteoporosis. For this reason, some doctors recommend assessing bone health before starting treatment and maintaining an adequate intake of calcium and vitamin D.

In addition, experts warn that the expansion of access could outpace the healthcare system’s ability to provide the necessary clinical support.

Logistics

The rollout also poses logistical challenges. Clinics, doctors, and pharmacies could face a sharp increase in demand, while the pre-authorization process could delay the start of treatment for some patients.

Added to this is uncertainty about the program’s future. Unless the federal government decides to extend it or Congress amends the current legislation, coverage will end in late 2027.

The cost is also a subject of debate. Medicare will cover approximately $250 per patient per month, while beneficiaries will contribute $50. If millions of people participate in the program, federal spending would amount to billions of dollars a year.