A new analysis from health policy research organization KFF estimates that nearly 4 million Medicare beneficiaries could qualify for the Medicare GLP-1 Bridge program, a temporary demonstration initiative designed to expand access to weight management medications while evaluating their impact on Medicare spending.
The program, launched on July 1, will run through 2027 and provides eligible Medicare Part D beneficiaries with access to the GLP-1 medicines Wegovy, Zepbound and Foundayo for a monthly copayment of $50. Eligibility is limited to beneficiaries with a body mass index (BMI) of at least 35, or a BMI of 27 or greater accompanied by qualifying health conditions. Participants must also not have conditions, such as type 2 diabetes, that already qualify them for Medicare-covered GLP-1 treatment, and they cannot have filled a GLP-1 prescription through their Part D plan earlier in the year.
Using Medicare claims data from 2023, KFF estimated that more than 13 million beneficiaries met the BMI criteria. Of those, approximately 10 million were enrolled in Medicare Part D and satisfied the clinical requirements. After applying the remaining eligibility criteria, an estimated 3.8 million beneficiaries qualified for the demonstration program.
The report projects that Medicare's costs will vary considerably depending on participation. If between 10% and 25% of eligible beneficiaries fill a prescription each month, the program could cost between $1.3 billion and $3.3 billion. If participation reaches 50% to 75%, projected spending increases to between $6.7 billion and $10 billion.
KFF noted that overall costs will depend on enrolment levels during 2026 and 2027, prescription uptake and long-term adherence. The report's authors wrote, “The ultimate cost to the federal government of the Medicare GLP-1 Bridge will depend on actual participation numbers and adherence during the 18-month program, as well as potential cost offsets from savings that might accrue over time due to beneficiary health improvements from GLP-1 use for weight reduction and weight management.”
The demonstration begins as GLP-1 medicines continue to play a growing role in U.S. healthcare spending, with prescription drug costs contributing to the increase in national healthcare expenditures reported over the past year.
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