• Starting Wednesday, in-demand weight loss drugs like Wegovy and Zepbound will be available to some Medicare beneficiaries for just $50
• Eligibility is limited, and the program lasts through next year
• The new program creates a loophole — but one that means some people who need the drugs most, such as diabetics, might have to pay more.

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Some Medicare beneficiaries will be able to get weight loss drugs at just $50 a month starting Wednesday — a big win if compared to sticker prices of $1,000 or more without insurance.

But eligibility is limited, meaning some patients who need the drugs — diabetics or those with severe sleep apnea, for example — may still have to pay more, depending on insurance.

Moreover, the program is short-lived; it ends Dec. 31, 2027.

And at least one Michigan doctor worries that, as doctors write prescriptions to meet a surge in demand, they may do so without the staff and programming in place to support the patients in changing their diet and making the kind of lifelong behavior changes for lasting benefits.

It’s a combination of factors that might create “pandemonium,” at least at first, said Dr. Jonathan Gabison, an Ann Arbor-based family medicine doctor who is board certified in obesity medicine.

Demand for GLP-1 drugs has exploded, in part, because of their success by slowing down digestion and mimicking the body’s naturally occurring hormone that signals the feeling of being full. More than cosmetic, they have been effective against a variety of conditions and diseases — diabetes, heart disease, and sleep apnea, among them.

“There’s going to be a very strong wave of patients asking for these medications on this program, and we are going to feel a little bit overwhelmed,” he told Bridge.

Related:

• Michigan cuts off weight-loss drugs for most Medicaid patients, saving $240M
• Blue Cross Blue Shield of Michigan won’t cover popular weight-loss drugs
• 1 in 5 Michigan kids are obese. Doctors are turning to weight loss drugs

But the bottom line is that more people will have access to the drugs who otherwise couldn’t afford them, said Dr. Habeeb Suara, a family medicine doctor at the Inkster office of Western Wayne Family Health Centers, a network of clinics in southeast Michigan. 

At least weekly, he said, he sees patients who could benefit from GLP-1 drugs, but whose insurance doesn’t cover them. (Michigan Medicaid and Blue Cross Blue Shield of Michigan are among insurers that have limited coverage for the drugs.)

Even if the program is short-lived, he said, it offers access that they otherwise don’t have now.

“I can see a lot of patients who will benefit from this,” he said.

Here’s what to know:

What is the program?

It’s a very short-term national demonstration program — 18 months long — called the Medicare GLP-1 Bridge, created by the US Centers for Medicare and Medicaid Services and administered by insurance giant Humana.

It was designed to increase access for those who are seeking “solely to reduce excess body weight or maintain weight reduction,” rather than, say, to control diabetes, according to CMS. 

It does so by creating a program outside of Medicare’s Part D drug program, which by law, can’t cover weight loss drugs for weight loss only. 

While the program’s back end operates outside of Medicare Part D, it’s only open to people with Medicare drug coverage.

“These treatments are a major medical advancement, but too many seniors are currently unable to access them due to high cost,” CMS Administrator Dr. Mehmet Oz said in a statement. “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.”

What drugs are covered?

People who otherwise might have skipped the GLP-1 injectable drugs might be more interested now, since some weight loss drugs are now available in pill form.

The new program covers these:

• Foundayo — tablets
• Wegovy — injection or tablets
• Zepbound — KwikPen only. It does not cover single-dose Zepbound vials or pens

How many Michiganders will be eligible for the program?

It’s not immediately clear.

On one hand, Michigan has some of the highest obesity rates in the nation; and about 1 in 3 Michiganders 65 and older is considered obese.

Moreover, about 2.3 million Michiganders are now covered by Medicare, and the vast majority — just under 2 million — have some coverage under Part D, which pays for drugs. 

That includes anyone with a standalone Part D plan or Part D as part of a Medicare Advantage plan, a Special Needs Plan (SNP) Medicare plan, an employer or union group waiver plan, or a Limited Income Newly Eligible Transition. You can find out more about coverage details here.

On the other hand, eligibility is narrow. It depends on a patient’s body mass index and whether they have certain pre-existing health conditions. (See below.) 

Because the program works outside of Medicare Part D, a doctor doesn’t need to accept Medicare to prescribe the drugs through this program. Gabison said it’s not yet clear what that means for operations at doctors’ offices.

Use the short questionnaire on this Medicare webpage to find out if you’re eligible.

Is $50 the real cost?

Yes, but there are important details.

Since the program works outside of Part D, the $50 a month does not apply to the maximum out-of-pocket cost in Part D, which this year is set at $2,100.

In other words, a beneficiary that remains on the drugs for the duration of the 18-month program would pay $900, and that money would be in addition to any expenses for Part D drugs.

Additionally, there’s no low-income subsidy available, as there is in Part D, and beneficiaries cannot buy them on a payment plan, as they would for other drugs covered by Part D.

Who picks up the rest of the cost?

Medicare will pick up the $245 cost of the drug, minus the $50 copay, that was negotiated with the manufacturers.

Cost to taxpayers could range from $1.3 billion to $10 billion over the 18 months, depending on beneficiaries’ interest, according to the San Francisco-based health care research nonprofit, KFF. 

However, the program could lead to health care savings in the long run as the drugs lead to healthier outcomes, KFF researchers said.

What about those who aren’t eligible?

Part D still covers weight loss drugs for people with certain conditions — Type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease, for example. The cost depends on your policy. And unlike the temporary Bridge program, the cost in Part D counts toward your true out-of-pocket cost, which is set at $2,100 this year.

Once you’ve reached that cap, you face no more copayment or coinsurance for Part D drugs for the rest of 2026. 

Beyond Medicare, the Bridge program and other traditional insurance, there are other ways to obtain weight loss drugs at a discount. GoodRx and TrumpRx, are two websites that can offer a starting point.

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