Eligible Medicare beneficiaries finally have a path to access to FDA-approved GLP-1 medications to treat obesity. Beginning July 1, a pilot Bridge program began offering 18 months of Medicare coverage, dramatically reducing the barriers that have kept many seniors from accessing the increasingly popular and effective drugs.
Medicare Part D has long been prohibited from covering medications solely to treat obesity, though it covers GLP-1s for related conditions like sleep apnea, diabetes and metabolic disorders. The medical consensus that obesity itself is a chronic disease with multiple causes supports this movement toward broader coverage of obesity treatment.
GLP-1 medications have shown remarkable benefits for weight management, but also unexpected reductions in addictive behaviors like smoking and drinking alcohol, lessened cancer risks and improvements in mental health. The rate of obesity in the United States is falling for the first time in recent memory, and diagnoses of diabetes have stabilized.
Bridge Remains, Permanent Plan on Hold
Eligible Medicare participants with Part D coverage will pay a $50 copay for a month’s supply of GLP-1 medication while receiving treatment under the Bridge program. The Strategies to Overcome and Prevent (STOP) Obesity Alliance has launched an awareness campaign to “publicize this opportunity to people with obesity and the providers that care for them.”
The Bridge program was originally intended to serve as a transition to a broader Medicare obesity benefit, the Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) model, but that plan has been placed on hold after a number of contracted insurers declined to participate, citing high costs and inadequate data. The Bridge program then became the only way for seniors to access these medications, and Medicare announced it would extend the program through the end of 2027, while collecting more of the data insurers will need to craft future coverage.
Legislation Could Close the Coverage Gap
The path to permanently resolving the coverage gap may go through Congress. The Treat and Reduce Obesity Act (TROA), if passed, would end Medicare Part D’s historical ban on funding treatments for obesity.
Codifying access to obesity management medications through legislation offers the most secure medical future for seniors. It also affirms the prevailing clinical view of obesity as a distinct chronic condition, deserving of medical treatment even before complications emerge. Treating seniors living with obesity before they develop secondary conditions could offer long-term savings as well as improved outcomes for Medicare patients.