The temporary Medicare program opens obesity-drug coverage to millions of eligible seniors, but prior authorization, clinic capacity and uncertainty after 2027 could complicate the rollout.
Eligible Medicare beneficiaries can begin accessing obesity drugs through the Bridge demonstration program starting July 1 for a $50 monthly copay, opening coverage for the first time to millions of older Americans and creating a potentially significant new market for Novo Nordisk and Eli Lilly. The program temporarily sidesteps Medicare's longstanding ban on covering drugs used solely for obesity by funding access outside standard Part D plan liability. Beneficiaries must have Part D coverage, obtain a prescription and secure prior authorization through a process handled by Humana, which CMS contracted to process approvals. Eligible patients include people with a body mass index of 35 or higher and some with lower BMIs who also have related conditions such as prediabetes or uncontrolled hypertension. Patients already receiving GLP-1 coverage through Part D for uses Medicare already covers, including Type 2 diabetes, cardiovascular disease risk reduction or sleep apnea, are excluded. CMS officials said several million beneficiaries are expected to use the program, while Novo and Lilly estimate roughly 15 million to 20 million older adults in Medicare could qualify for weight-loss drugs. Still, physicians warned the launch could strain clinics, pharmacies and the prior authorization system, and some experts said limited public awareness may delay uptake. The benefit is also temporary. Bridge is scheduled to expire at the end of 2027 unless extended or replaced, leaving uncertainty for patients starting therapies that many experts view as long-term treatment. CMS had initially planned for Bridge to transition into a longer-term voluntary program called Balance, but insurers including CVS and UnitedHealthcare declined to participate. Supporters say a more durable solution would require either broader insurer participation or a change in federal law, such as the Treat and Reduce Obesity Act.