politics
Medicare Begins Temporary Coverage of GLP-1 Drugs for Obesity
A short-term pilot program allowing Medicare to cover GLP-1 medications for obesity treatment begins July 2 and runs through 2027. Beneficiaries will pay $50 monthly while manufacturers set a $245 price per drug. The program covers obesity treatment only and requires prior authorization.
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A temporary Medicare pilot program covering GLP-1 medications for obesity treatment begins July 2 and continues through 2027. Medicare is generally prohibited by law from covering weight-loss drugs, but the Centers for Medicare and Medicaid Services can test new payment models through short-term pilot programs.
Eli Lilly and Novo Nordisk agreed to a monthly price of $245 for their respective GLP-1 drugs in exchange for access to Medicare beneficiaries.
Beneficiaries will pay $50 per month for the medications, though the cost will not count toward their Part D deductible. Coverage applies only to obesity treatment and excludes diabetes or other medical indications. Patients must complete a prior authorization process before receiving coverage.
Eligibility requires a body mass index of 35 or higher, or a BMI between 30 and 35 with additional conditions such as uncontrolled high blood pressure, prediabetes, prior heart attack or stroke, blocked arteries, chronic kidney disease at Stage 3a or higher, or diastolic heart failure.
Medicare at CMS, stated the agency anticipates the program will begin with single-digit millions of beneficiaries. A KFF estimate based on 2023 data projected that 3.8 million beneficiaries could meet all eligibility criteria. The program ends in 2027, after which coverage terms remain undetermined.
