CMS To Make GLP-1s Eligible to Medicare Patients for $50 a Month

The administrator of the Centers for Medicare and Medicaid Services, Dr. Mehmet Oz, says the Trump Administration will make it more affordable for elderly Americans to shed pounds using popular GLP-1 drugs.The weight loss drugs can cost between $149 and $1,500 a month. A pre-filled Zepbound pen can cost $1,000 a month, or a single-dose vial can cost $449 a month, according to U.S. News & World Report. Speaking to reporters at the White House on Tuesday, Dr. Oz said that Medicare beneficiaries who are eligible for GLP-1 drugs will be able to get those products through a bridge program for $50 a month between July 1 and December 2027. Dr. Oz said the medications can be “life-changing and even life-saving” because of their “impact on weight and downstream complications like diabetes and hypertension, and all the things they cause like kidney failure and heart disease and strokes and dementia.”“All those risk factors are going to be mitigated, we believe, if these medications are used correctly,” he said.The CMS administrator told reporters that making the medications cheaper and more accessible for Medicare beneficiaries will also benefit the American taxpayer, if the products are “used correctly,” because the elderly Americans will “get the weight loss they desire with the downstream benefits” of limiting risk factors for other health problems. The Trump Administration negotiated the prices with two makers of the weight loss medications, Eli Lilly and Novo Nordisk, after several insurers chose not to opt in to the Better Approaches to Lifestyle and Nutrition for Comprehensive Health program, which would have mandated that Part D insurers cover the weight loss products. The program will offer Wegovy, the KwikPen version of Zepbound, and the Foundayo pill. To be eligible for the program, beneficiaries must be enrolled in Medicare Part D, have a body mass index of at least 27, and have a health condition such as diabetes. Those with a body mass index of at least 35 will be automatically eligible. GLP-1s have gained popularity as the average user tends to lose between 10 and 15 percent of their body weight. Last November, a KFF poll found that 12 percent of adults said they were currently taking a GLP-1 drug, while 18 percent said they had taken one “at some point.”The Mayo Clinic notes that they have also been shown to provide better blood sugar control, lower blood pressure, and lower cholesterol. However, some data has found that more than 30 percent of the weight loss can come from muscle, which might not be regained. Some rare risks of the medication include pancreatitis, gallbladder disease, and acute kidney injury. While Dr. Oz touted the potential health and financial benefits of the weight loss products over the next two years, it is unclear whether they will be realized. A study published in JAMA in January 2025 found that 47 percent of senior citizens with type 2 diabetes and 65 percent without diabetes stopped using GLP-1s within a year.

CMS To Make GLP-1s Eligible to Medicare Patients for $50 a Month

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