This marks the first time Medicare has covered obesity medications, opening a vast new patient pool for Novo Nordisk and Eli Lilly. Medicare Part D already covers certain GLP-1s for diabetes and heart conditions, but federal statute previously barred covering obesity alone. Through the Bridge demonstration program, the restriction is bypassed for eligible individuals, including those who are overweight and have prediabetes or uncontrolled hypertension.
As of last week, more than 69 million people were enrolled in Medicare. According to Chris Klomp, who directs Medicare and serves as a deputy administrator at CMS, "several million" beneficiaries are likely to use the program, as he stated during the Aspen Ideas Festival. Novo and Lilly estimate that 15 million to 20 million older adults in Medicare qualify for weight loss drugs.
But the rollout may face hiccups. Providers must submit prior authorization requests that confirm patients satisfy eligibility criteria - a step some physicians have called burdensome. Some doctors also worry that a surge in demand could strain busy clinics and pharmacies, while others pointed to a lack of broader public awareness about the program.
A larger uncertainty looms: If the Trump administration does not extend or replace the demonstration, obesity drug coverage will end in December 2027. Making it permanent would need a shift in federal legislation or a consensus among private insurers to offer the drugs in Part D plans. That leaves patients who start treatments - often considered lifelong - in an ambiguous position.
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Juliette Cubanski, head of KFF's Medicare policy research, said, "It's good news that Medicare is rolling out this program, but it is temporary, so it's really not clear at this point what happens after the end of the 18-month program duration."
Both Lilly and Novo have introduced cash discount programs, but those remain unaffordable for some. Crucially, the $50 copay does not apply to the Part D deductible or the $2,100 annual out-of-pocket limit, as noted by Rachel Schmidt, a Georgetown University researcher in public policy. For many older adults, an extra $600 annually may still be burdensome - a quarter of Medicare beneficiaries had incomes below $24,600 in 2024, according to KFF.
Still, the coverage "is going to improve access to so many Americans who need these medications, and either are going without or using their hard-earned money in retirement to pay for them," said Dr. Holly Lofton, director of NYU Langone's weight management program.
The Bridge program operates differently than standard Medicare drug coverage. It is available to beneficiaries with Part D, but private insurers do not pay - the program is financed by public funds and patient copayments, and unlike typical Part D plans, they do not decide who qualifies or approve the coverage. Instead, a clinician must verify that the individual satisfies clinical criteria related to weight and health. Those eligible include people with a BMI of 35 or above, along with certain others who have a lower BMI but conditions like prediabetes, a history of heart attack, stroke, or arterial blockages in the limbs.
This eligibility framework allows many individuals who were previously unable to get Medicare coverage for weight-loss medications to now qualify. Lofton called the criteria "appropriate" and said they are broader than typical commercial insurance plans. Including those with prediabetes is intended to stave off diabetes among Medicare enrollees, ultimately cutting national healthcare spending, she added.
To get coverage, a provider sends a prescription, triggering a prior authorization request. The provider completes the request to certify eligibility and sends the form to Humana, the company chosen by CMS to handle authorization.
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