Medicare now covers GLP-1 drugs like semaglutide (Ozempic, Wegovy) and tirzepatide (Zepbound, Mounjaro) for weight loss through a new temporary program. The GLP-1 Bridge program lets eligible beneficiaries access these medications at reduced costs before the full Medicare coverage begins in 2026.
Here's what qualifies you. You must be enrolled in Medicare Part D, have a body mass index of 27 or higher, and have at least one weight-related condition like type 2 diabetes, heart disease, or high blood pressure. Medicare Part D plans must cover at least one GLP-1 drug in each class.
The out-of-pocket costs work like this. Your Part D plan determines your actual copay, which typically ranges from $0 to $35 per dose depending on your plan's formulary tier. Some plans charge no copay at all for these medications. You'll pay these copays for the duration of your prescription, but the program ends when full Medicare GLP-1 coverage launches in 2026.
The catch involves availability and timing. Not every Medicare Part D plan participates. You need to check your specific plan's formulary to see which GLP-1 drugs are covered and at what cost tier. Switching plans during open enrollment, which runs October 15 through December 7, gives you a path to better coverage if your current plan doesn't offer affordable access.
Pharmacies may experience supply constraints, and some patients report waiting lists. Insurance approval requires documentation of your weight-related condition from your doctor.
For beneficiaries who faced $900 to $1,500 monthly costs before this program, the savings matter significantly. Even a $35 copay reduces expenses by 95 percent compared to the uninsured price.
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